本文選題：腎移植 + BK病毒�。� 參考：《南京大學》2017年碩士論文

【摘要】：腎移植術后BK病毒感染及危險因素分析目的:研究國內腎移植術后BK病毒(BK virus,BKV)感染情況,分析腎移植術后BKV感染的危險因素。方法:選取2015年6月—2016年7月于南京軍區(qū)南京總醫(yī)院常規(guī)接受血、尿液BKV DNA檢測的腎移植術后受者作為研究對象,并將同時期接受檢測的尿毒癥透析患者、健康活體供者作為對照組。了解腎移植術后BKV感染情況,探討腎移植受者的一般情況、術后并發(fā)癥及免疫抑制劑方案等因素對BKV感染是否有影響。結果:腎移植術后受者的尿液BKVDNA陽性率為19.9%,其中同時伴有血液BKVDNA陽性的發(fā)生率為1.3%,而尿毒癥透析患者、健康活體供者的尿液BKV DNA陽性率分別為6.3%、4.2%,后兩組患者的血液BKV DNA均陰性。腎移植術后受者的尿液BKV DNA陽性率較尿毒癥透析患者、健康活體供者增加(P0.001),而尿毒癥透析患者、健康活體供者的尿液BKVDNA陽性率相似(P=0.842)。單因素分析顯示:術后肺部感染、急性排斥反應及術后服用他克莫司(Tacrolimus,FK506)與腎移植術后BKV感染相關(P0.05),而受者的性別、年齡、并發(fā)糖尿病、移植腎延遲腎功能恢復(delayed recovery of graft function,DGF)及術后服用環(huán)孢霉素A(Cyclosporine,CsA)、嗎替麥考酚酸酯(Mycophenolate Mofetil,MMF)與BKV感染均無相關性('P0.05);進一步行多因素分析顯示:術后肺部感染(OR[95%CI],3.468[1.227-9.802];P=0.019)、急性排斥反應(OR[95%CI],2.645[1.142-6.127];P =0.023)、術后服用 FK506(OR[95%CI],2.408[1.104-5.254];P-0.027)仍與腎移植術后BKV感染相關。結論:腎移植術后BKV感染的發(fā)生率明顯增加。術后肺部感染、急性排斥反應及應用以FK506為主的免疫抑制劑方案均可增加腎移植術后BKV感染的風險。影響B(tài)K病毒相關性腎病進展的相關免疫組織化學因素分析目的:觀察腎移植術后BK病毒相關性腎病(BK virus associated renal allograft nephropathy,BKVAN)患者不同階段免疫組織化學因素的變化情況,探討其臨床意義。方法:選取南京軍區(qū)南京總醫(yī)院經病理明確診斷為BKVAN的53例患者。根據第3版美國移植協(xié)會感染診療指南,將BKVAN患者分為輕度12例(Stage A)、中度22例(Stage B)、重度19例(Stage C),比較3組BKVAN患者移植腎組織中CD4+、CD8+、CD20+、CD138+、CD68+細胞,白細胞介素2受體(IL-2R)及腎小管上皮細胞HLA-DR的陽性表達變化情況。結果:BKVAN 患者腎組織中 CD4+、CD8+、CD20+、CD138+、CD68+細胞、IL-2R和腎小管上皮細胞HLA-DR均有陽性表達,且隨著BKVAN患者的病程進展,上述浸潤細胞的表達有增加趨勢。其中,重度組與輕度組相比CD4+、CD20+、CD138+、CD68+細胞的浸潤具有顯著統(tǒng)計學差異(P0.01),而三組間CD8+細胞、IL-2R和腎小管上皮細胞HLA-DR的陽性表達均無統(tǒng)計學差異。結論:BKV誘發(fā)腎組織中T淋巴細胞、B淋巴細胞及單核巨噬細胞免疫系統(tǒng)的活化,其中移植腎組織中CD4+、CD20+、CD138+及CD68+細胞的顯著增加是造成BKVAN進行性加重的主要因素。
[Abstract]:Analysis of BK virus infection and risk factors after renal transplantation objective: to study the BK virus BK virus BKV infection after renal transplantation in China and to analyze the risk factors of BK virus infection after renal transplantation. Methods: renal transplant recipients who received blood and urine BKV DNA from June 2015 to July 2016 in Nanjing General Hospital of Nanjing military region were selected as the study subjects, and the uremic dialysis patients who were tested at the same time were selected. Healthy living donors served as control group. To investigate the infection of BKV after renal transplantation, to explore the general situation of renal transplant recipients, postoperative complications and immunosuppressive regimen, and other factors affecting BKV infection. Results: the positive rate of urine BKVDNA was 19.9 in recipients of renal transplantation, and the incidence of positive BKVDNA in blood was 1.3. The positive rate of urine BKV DNA in uremic dialysis patients and healthy living donors was 6.30.The BKV DNA in blood of the latter two groups was negative. The positive rate of urine BKV DNA in recipients after renal transplantation was higher than that in uremic dialysis patients, and the positive rate of urine BKVDNA in healthy donors was similar to that in uremic dialysis patients. Univariate analysis showed that postoperative pulmonary infection, acute rejection and tacrolimus FK506) were associated with BKV infection after renal transplantation (P 0.05), and the recipients had sex, age, and diabetes mellitus. Delayed renal function recovery and postoperative administration of cyclosporine, mycophenolate mofetil (MMF) were not associated with BKV infection. Further multivariate analysis showed that OR [95%CI] 3.468 [1.227-9.802], acute rejection OR [95%CI] 2.645 [1.142-6.127] P FK506(OR [95%CI] 2.408 [1.104-5.254] P-0.027 was still associated with BKV infection after renal transplantation. Conclusion: the incidence of BKV infection increased significantly after renal transplantation. Postoperative pulmonary infection, acute rejection and the use of immunosuppressant regimen based on FK506 can increase the risk of BKV infection after renal transplantation. Analysis of immunocytochemical factors affecting the progression of BK virus associated nephropathy objective: to observe the changes of immunocytochemical factors in patients with BK virus associated renal allograft nephropathy after renal transplantation and to explore its clinical significance. Methods: 53 patients with BKVAN diagnosed by pathology in Nanjing General Hospital of Nanjing military region were selected. According to the third edition of the American Transplantation Association guidelines for the diagnosis and treatment of infection, the patients with BKVAN were divided into three groups: mild 12 cases with stage A, moderate 22 cases with stage BV, severe 19 cases with stage C, and compared the CD138 CD68 cells of CD4 CD8 + CD20 and CD138 in three groups of patients with BKVAN. The positive expression of IL 2 receptor IL 2 R) and HLA-DR in renal tubular epithelial cells. Results the positive expression of IL-2R and HLA-DR in the renal tissue of CD4 / CD8 / CD20 / CD138 / CD138 / CD138 / CD68 was observed in the patients with BKVAN. The expression of the above infiltrating cells tended to increase with the progression of the disease course of BKVAN. There was significant difference in the infiltration of CD4 CD20 CD138 and CD68 cells between the severe group and the mild group (P 0.01), but there was no significant difference in the expression of IL-2R in CD8 cells and HLA-DR expression in renal tubular epithelial cells among the three groups. Conclusion the activation of T lymphocyte B lymphocytes and mononuclear macrophage immune system was induced by BKV. The significant increase of CD4 CD20 CD138 and CD68 cells was the main factor that caused the progressive aggravation of BKVAN.
【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699.2
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本文編號：1832249