肾移植后BK病毒相关性肾病的临床诊断方法的比较
Comparison of clinical diagnoses of BK virus-associated nephropathy in renal transplant recipients
目的 探讨肾移植后BK病毒相关性肾病(BKVAN)的临床诊断特点及无创检测对于预测不同病理分期BKVAN的临床意义.方法 选择2006年1月至2013年8月接受移植肾穿刺活检的479例肾移植受者,进行尿沉渣Decoy细胞计数;同时检测尿、血标本中BK病毒DNA含量.并且运用常规病理染色、免疫组织化学染色的方法检查移植肾组织,确定BKVAN的诊断,并进行BKVAN病理分期.比较不同的诊断方法预测不同病理分期BKVAN的临床意义.结果 479例受者中共诊断BKVAN 39例,发生率为8.1%(39/479),其中BKVAN A期9例,B期25例,C期5例.免疫抑制方案均为他克莫司+吗替麦考酚酯+皮质激素.确诊时血肌酐水平出现不同程度上升(平均为194.9 μmol/L),尿比重降低(平均为1.007),34例受者尿蛋白阴性.BKVAN组的尿沉渣Decoy细胞阳性率、BK病毒尿症、BK病毒血症及BK病毒DNA阳性率均高于非BKVAN组(P<0.05).尿Decoy细胞预测BKVAN的阴性预测值为0.949,敏感度为0.995,均最高;BK病毒血症预测BKVAN的阳性预测值为0.770,特异性为0.977,均最高.三项筛查指标预测BKVAN B期的敏感性、特异性、阳性预测值、阴性预测值最高.结论 尿沉渣细胞学结合BK病毒DNA的血、尿检测,并注意观察肾移植受者常规随访检查的细节,可以及时发现移植肾BKVAN.
更多Objective To investigate the clinical diagnoses of BK virus-associated nephropathy (BKVAN) and estimate the utility of screening methods for BKVAN in different patterns.Method We used three screening methods for BKVAN including quantitative PCR assay for BKV DNA load in urine and plasma,and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 479 patients.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry,and classified into three categories of BKVAN.These three screening methods were compared for prediction of different patterns of BKVAN.Results BKVAN was diagnosed in 39 (8.1%) of 479 renal recipients.There were 9,25 and 5 cases of BKVAN at stage A,B and C,respectively.FK506 + MMF immunosuppressive agents were used in these 39 BKVAN recipients.The average level of serum creatinine and the specific gravity of urine were 194.9 μmol/L and 1.007 respectively.No proteinuria occurred in 34 BKVAN recipients.The incidence and the median level of the number of the decoy cells,and BK viral load in urine and plasma were higher in the BKVAN group than those in non-BKVAN group (P<0.05 for all).Decoy cells had a high negative predictive value of 94.9% and a high sensitivity of 99.5% for BKVAN.BK viremia had a high positive predictive value of 77.0% and a high specificity of 97.7% for BKVAN.Combined use of these three screening methods had a high sensitivity,specificity,negative predictive value and positive predictive value for BKVAN pattern B.Conclusion Urine cytology and BKV DNA detection in the urine and peripheral blood combined with the careful observation of the routine tests are very useful and sensitive for the evaluation of BKVAN in renal transplant recipients.
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