肾移植术后BK病毒感染患者血清、尿液BK病毒DNA载量与肾功能、免疫功能的相关性-东南大学学报医学版

肾移植术后BK病毒感染患者血清、尿液BK病毒DNA载量与肾功能、免疫功能的相关性

单位：郑州人民医院肾移植科, 河南郑州 450000

分类号：R699.2

出版年·卷·期（页码）：2023·42·第五期（718-723）

摘要：

目的:分析肾移植术后BK病毒(BKV)感染患者血清、尿液BKV DNA载量与肾功能、免疫功能的相关性。方法:选择2019年1月至2022年1月间在本院接受肾移植的132例患者,测定患者肾移植后12个月时肾功能指标,流式细胞术分析患者肾移植后12个月时免疫功能指标CD4⁺T细胞、CD8⁺T细胞水平,并计算CD4⁺/CD8⁺值;采用全自动生化分析仪检测肾功能指标肾小球滤过率(GFR)、血肌酐(SCr)、尿素氮(BUN)、胱抑素C(Cys-C);实时荧光定量PCR法分析患者肾移植术后0.5、1、3、6、9、12、15个月时尿液以及血液中BKV DNA载量,根据术后12个月时BKV DNA载量分别将尿液、血液标本分为尿BKV DNA阴性组、尿BKV DNA低载量组、尿BKV DNA中载量组、尿BKV DNA高载量组以及血BKV DNA阴性组、血BKV DNA低载量组、血BKV DNA中载量组、血BKV DNA高载量组,比较组间肾功能指标以及免疫功能指标;Pearson法分析患者尿BKV DNA载量、血BKV DNA载量与患者肾功能、免疫功能相关性。结果:132例接受肾移植患者中58例尿BKV DNA阳性,即病毒尿症,发生率为43.93%(58/132),32例血BKV DNA阳性,即病毒血症,发生率为24.24%(32/132),5例病理学活检阳性为BKV肾病,发生率为3.79%(5/132)。尿BKV DNA载量与血BKV DNA载量随时间变化趋势基本一致,于肾移植后6个月升至最高,随后降低,经对数转化后,尿BKV DNA高于血BKV DNA载量,二者比较差异有统计学意义(P<0.05);尿BKV DNA载量与CD4⁺T细胞、CD4⁺/CD8⁺水平呈负相关(P<0.05),与CD8⁺T细胞水平呈正相关(P<0.05);血BKV DNA载量与CD4⁺T细胞水平、CD4⁺/CD8⁺水平及GFR呈负相关(P<0.05),与CD8⁺T细胞、SCr、BUN、Cys-C水平呈正相关(P<0.05)。结论:尿、血BKV DNA载量与肾移植后患者免疫功能有关,高水平尿、血BKV DNA载量与肾功能相关。

Objective: To analyze the correlation of BKV DNA load in serum and urine with renal function and immune function in patients with BK virus(BKV) infection after kidney transplantation. Methods: A total of 132 patients who received kidney transplantation in our hospital from January 2019 to January 2022 were included in this study. The renal function indexes of the patients at 12 months after kidney transplantation were determined; flow cytometry was applied to analyze the levels of immune function indicators CD4⁺ T cells and CD8⁺ T cells at 12 months after kidney transplantation, and the CD4⁺/CD8⁺ ratio was calculated; an automatic biochemical analyzer was applied to detect renal function indicators-glomerular filtration rate(GFR), serum creatinine(SCr), blood urea nitrogen(BUN) and cystatin C(Cys-C), and real-time fluorescence quantitative PCR was applied to analyze the BKV DNA load in urine and blood of patients at 0.5, 1, 3, 6, 9, 12, and 15 months after kidney transplantation.According to the BKV DNA load at 12 months after operation, the urine and blood samples were divided into urinary BKV DNA negative group, urinary BKV DNA low load group, urinary BKV DNA medium load group, urinary BKV DNA high load group and blood BKV DNA negative group, blood BKV DNA low load group, blood BKV DNA medium load group, blood BKV DNA high load group, the renal function indexes and immune function indexes were compared between groups; Pearson method was applied to analyze the correlation between urinary BKV DNA load, blood BKV DNA load and renal function, immune function of patients. Results: 58 of 132 patients who received kidney transplantation were positive for urinary BKV DNA, i.e., viruria, with an incidence of 43.93%(58/132), 32 were positive for blood BKV DNA, i.e., viremia, with an incidence of 24.24%(32/132), and 5 had a positive pathology biopsy for BKV nephropathy, with an incidence of 3.79%(5/132). Urinary BKV DNA load and blood BKV DNA load were basically the same with time. They rose to the highest at 6 months after kidney transplantation and then decreased. After logarithmic transformation, urinary BKV DNA load was higher than blood BKV DNA load(P<0.05); urinary BKV DNA load was negatively correlated with CD4⁺T cells, CD4⁺/CD8⁺ (P<0.05), and positively correlated with CD8⁺T cells(P<0.05); blood BKV DNA load was negatively correlated with CD4⁺T cells, CD4⁺/CD8⁺, and GFR(P<0.05), and positively correlated with CD8⁺T cells, SCr, BUN, and CyS-C levels(P<0.05). Conclusion: Urine and blood BKV DNA load are related to the immune function of patients after kidney transplantation, while high level of urine, blood BKV DNA load were related to renal function.

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