Abstract:

Objective To summarize and analyze the treatment and prognosis of BK virus nephropathy （BKVN）after renal transplantation. Methods The clinical data of 101 patients with polyoma virusnephropathy（PVN） who underwent transplantation renal biopsy between January 2006 and October 2016 in the organ transplantation section of The First Affiliated Hospital of Sun Yat-sen University were retrospective analyzed. Urinary sediment Decory cells were quantitated. The DNA loads in blood and urine were detected. Results A total number of 101 PVN patients were enrolled. Ninety-eight patients of them were BKVN. The virus particles of the tubular epithelial cells in the nucleus could be observed by electron microscopy. Forty of the ninety-eight patients showed that SV40T staining changed from flake to focal with a decrease in viremid. BKVN patients could be combined with cellular and humoral rejection. Blood tests of BKVN DNA showed a positive predictive value of 30%-85% for BKVN. Persistently positive of BKV DNA in plasma which is greater than 104 copies/ml，can be regarded as a indication for intervention. Conclusion Routine monitoring after transplantation，early diagnosis of BKVN， timely reduction of immunosuppression and then frequent screening for the possible rejection can improve the long-term survival of kidney allograft of BKVN patients.

摘要：

目的 总结分析肾移植后 BK 病毒性肾病的防治和预后。方法 回顾性分析 2006 年 1 月2016 年 10 月中山大学附属第一医院器官移植科行移植肾穿刺活检的 101 例多瘤病毒性肾病（PVN）患者 的临床资料，检测尿沉渣 Decoy 细胞计数、血和尿 BKV DNA 载量。结果 共纳入 101 例确诊为 PVN 的患 者，其中 98 例为 BK 病毒性肾病（BKVN），感染广泛的病例电镜下可观察到肾小管上皮细胞核内的病毒颗 粒，98 例中的 40 例患者进行重复活检显示随着病毒血病的下降 SV40T 的染色可由片状变为局灶性，BKVN 患者可合并出现细胞性或体液性排斥反应。BKV 血中的检测预测 BKVN 阳性预测值有 30% ～ 85%，血浆 BKV DNA 持续阳性及负荷＞ 10 4 copies/ml 可以作为治疗干预开始的依据。结论 术后规律监测早期发现移 植肾 BKVN 及时减少免疫抑制剂，并规律监测注意并发的排斥反应可提高移植肾 BKVN 的远期存活。