中华器官移植杂志2024，Vol.45Issue(1) ：41-46.DOI:10.3760/cma.j.cn421203-20230627-00016

肾移植术后静脉注射免疫球蛋白清除BK病毒和治疗BK病毒性肾病的疗效分析

Efficacies of intravenous immunoglobulin for kidney recipients for clearing BK virus and treating BK virus nephropathy

石韶华 王彩霞 郝晓军 杨军 刘婷婷 武小桐
中华器官移植杂志2024，Vol.45Issue(1) ：41-46.DOI:10.3760/cma.j.cn421203-20230627-00016
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肾移植术后静脉注射免疫球蛋白清除BK病毒和治疗BK病毒性肾病的疗效分析

Efficacies of intravenous immunoglobulin for kidney recipients for clearing BK virus and treating BK virus nephropathy

石韶华 1王彩霞 1郝晓军 1杨军 1刘婷婷 1武小桐1
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作者信息

  • 1. 山西省第二人民医院肾移植透析中心二区,太原 030001
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摘要

目的 探讨肾移植术后人免疫球蛋白(intravenous immunoglobulin,IVIG)清除BK病毒、治疗BK病毒性肾病(BK virus nephropathy,BKVN)的效果.方法 回顾性分析2018年3月1日至2022年3月31日山西省第二人民医院收治的确诊BKVN并接受IVIG治疗的13例肾移植受者的临床资料.比较受者BK病毒感染前、IVIG使用前和使用后第1、3、6、12个月的血、尿BK病毒DNA载量、血清肌酐和肾小球滤过率(glomerular filtration rate,GFR),采用单因素Cox回归分析法分析尿BK病毒清除失败的危险因素.结果 13例受者中,9例病理分期为A期,4例为B期.经IVIG治疗12个月后,13例受者血BK病毒转阴,6例尿BK病毒转阴,7例尿BK病毒DNA载量较前下降103拷贝/ml.13例受者IVIG使用前血BK病毒DNA载量、尿BK病毒DNA载量、GFR和血清肌酐分别为26 100(1 000,254 000)拷贝/ml、1 450(438,74 807)×106 拷贝/ml、(35.36±14.57)ml/min 和(208.50± 66.89)μmol/L,IVIG 使用 12 个月后分别为 0、0(0,0.58)×106拷贝/ml、(46.05±13.00)ml/min 和(175.38±50.64)μmol/L,前后比较,差异均有统计学意义(P=0.012、0.027、0.046和0.039).单因素Cox回归分析结果显示,初始病毒载量高(HR=0.780;95％CI:0.64～0.98,P=0.032)、合并移植肾排斥反应(HR=0.847,95％CI:0.52～0.93,P=0.013)和更高的 BKVN分级(HR=0.426,95％CI:0.22～0.81,P=0.010)是尿BK病毒清除失败的危险因素.结论 IVIG清除BK病毒效果较好,治疗BKVN有效,治疗后移植肾功能稳定或好转.

Abstract

Objective To evaluate the efficacies of intravenous immunoglobulin(IVIG)in the clearance of Bovine Kobu(BK)virus and treatment of BK virus nephropathy(BKVN)in kidney transplantation recipients.Methods From March 1,2018 to March 31,2022,the relevant clinical data were retrospectively reviewed for 13 kidney transplantation recipients with histologically proven BKVN on a full course of IVIG.The changes of serum creatinine and glomerular filtration rate(GFR)were compared before and after Month 1/3/6/12.Univariate Cox regression analysis was performed for examining the overall risk factors of BK virus clearance failure.Results kidney transplantation(12 cases)and combined pancreatorenal transplantation(1 case)were performed.Among them,9/13 patients were pathologically classified as stage A(early changes without tubular necrosis)and another 4 cases as stage B(active nephropathy with viral tubular necrosis).After IVIG dosing,all patients with BK virus in blood turned negative.Urinary BK virus DNA load of 7 patients with BK virus declined by 103 copies/ml,and 6 patients with BK virus in urine turned negative.Blood BK viral DNA load,urinary BK viral DNA load,GFR and serum creatinine before IVIG were 26 100(1 000,254 000)copies/ml and 1 450(438,7 480)×106 copies/ml,(35.36±14.57)ml/min and(208.50±66.89)μmol/L,respectively,after 12 months of use of IVIG were 0、0(0,0.58)×106 copies/ml、(46.05±13.00)ml/min and(175.38±50.64)μmol/L,the differences were statistically significant(P=0.012,0.027,0.046 and 0.039).Univariate Cox regression analysis showed that the overall risk factor for viral clearance failure was high initial viral load(HR=0.780,95％CI:0.64-0.98,P=0.032),concurrent transplanted kidney rejection(HR=0.847,95％CI:0.52-0.93,P=0.013)and higher BKVN grade(HR=0.426,95％CI:0.22-0.81,P=0.010)were the overall risk factors for urinary BK virus clearance failure.No major adverse events occurred.Conclusions IVIG may achieve a high efficacy of BK virus clearance.IVIG is effective in the treatment of BKVN.The graft renal function was stable or improved after treatment.

关键词

肾移植/静脉注射免疫球蛋白/BK病毒/BK病毒性肾病/移植肾功能

Key words

Kidney transplantation/Intravenous immunoglobulin/Bovine Kobu virus/BK virus nephropathy/Graft renal function

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基金项目

山西省卫生健康委科研项目(2023XG037)

山西省卫生健康委卫生健康科研项目(2023038)

出版年

2024
中华器官移植杂志
中华医学会

中华器官移植杂志

CSTPCD
影响因子：0.574
ISSN：0254-1785
参考文献量22
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