中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (40): 7411-7416.doi: 10.3969/j.issn.2095-4344.2012.40.001

• 肾移植 kidney transplantation •    下一篇

肾移植后多瘤病毒相关性肾病

季曙明，吴 迪，文吉秋，谢柯楠，程东瑞，孙启全，陈劲松，刘志红   

  1. 解放军南京军区南京总医院全军肾脏病研究所，南京大学临床医学院，江苏省南京市 210002
  • 收稿日期:2011-10-08 修回日期:2011-11-02 出版日期:2012-09-30 发布日期:2012-09-30
  • 通讯作者: 刘志红，院士，博士生导师，解放军南京军区南京总医院全军肾脏病研究所，南京大学临床医学院，江苏省南京市 210002 zhihong-liu@ hotmail.com
  • 作者简介:季曙明，男，1958年生，江苏省泰兴市人，汉族，1983年解放军第二军医大学毕业,主任医师，主要从事肾脏病和肾脏移植研究。 jishuming@ medmail.com.cn

BK virus associated nephropathy after kidney transplantation

BK virus associated nephropathy after kidney transplantation   

  1. Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
  • Received:2011-10-08 Revised:2011-11-02 Online:2012-09-30 Published:2012-09-30
  • Contact: Liu Zhi-hong, Academician, Doctoral supervisor, Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China zhihong-liu@ hotmail.com
  • About author:Ji Shu-ming, Chief physician, Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China jishuming@medmail.com.cn

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被引次数

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摘要：

背景：多瘤病毒感染是导致多瘤病毒相关性肾病和移植肾失功的重要原因之一。
目的：观察分析多瘤病毒相关性肾病的临床特征及其病理学特点。
方法：121例患者移植肾活检行多瘤病毒大T抗原染色，发现9例阳性诊断为多瘤病毒相关性肾病，利用SV-40 大 T 抗原免疫组织化学染色，对确认为多瘤病毒相关性肾病患者进行临床、病理、免疫荧光、免疫组织化学观察。
结果与结论：多瘤病毒相关性肾病组肾活检时检测霉酚酸-AUC 0-12和他克莫司血药浓度均明显高于同期非多瘤病毒相关性肾病组(P < 0.05)。9例活检组织经SV-40 大T抗原染色，肾皮质和髓质均可见散在的肾小管多瘤病毒阳性。免疫荧光IgG，IgM，IgA，C3，C4，C1q和C4d全阴性，所有肾组织病理均可见肾间质大量聚集的CD3，CD4，CD8，CD68阳性细胞，1例合并排斥反应者，人白细胞DR抗原和白细胞介素2受体高表达；不合并排斥者人白细胞DR抗原和白细胞介素2受体表达多小于5%。9例多瘤病毒相关性肾病患者随访均超过半年，移植肾失功1例，3例好转，2例稳定，3例恶化。结果表明，多瘤病毒相关性肾病的诊断主要依赖于移植肾活检组织病理；利用SV-40 大T 抗原免疫组织化学染色可提高多瘤病毒相关性肾病的诊断率；移植肾组织C4d、白细胞介素2受体和人白细胞DR抗原检测对多瘤病毒感染相关性肾病的鉴别诊断具有极其重要的临床价值。

关键词: 肾移植, 多瘤病毒, 多瘤病毒相关性肾病, 白细胞介素2受体, 排斥, 器官移植

Abstract:

BACKGROUND: Polyomavirus infection is an important cause of BK virus associated nephropathy (BKVAN) and renal allograft dysfunction.
OBJECTIVE: To investigate pathological features and clinical characteristics of BKVAN.
METHODS: Polyomavirus large T antigen staining of 121 transplant renal biopsy showed that nine cases were positively diagnosed as having BKVAN. Clinical, pathologic, immunofluorescence and immunohistochemistry observation of BKVAN patients were performed by anti-SV40 large T antibody staining.
RESULTS AND CONCLUSION: Mycophenolic acid-AUC 0-12 and tacrolimus blood concentration in the BKVAN group were higher than those in the no BKVAN group (P < 0.05). SV-40 large T antigen staining of nine cases of biopsy showed that there were scattered positive tubular polyomaviruses in the renal cortex and medulla. Immunofluorescence staining showed the negative expression of IgG, IgM, IgA, C3, C4, C1q and C4d. All the renal histopathological observation showed that a large number of CD3, CD4 and CD8, CD68-positive cells were aggregated in the renal interstitial. In one case of merge rejection, human leukocyte antigen DR and interleukin-2 receptor were highly expressed. However, the expressions of human leukocyte antigen DR and interleukin-2 receptor in non-merge rejection patients were almost less than 5%. The follow-up of nine cases of BKVAN was more than 6 months, one case of renal allograft dysfunction, three cases improved, two cases of stable and three cases of deterioration. Immunohistochemistry with SV-40 large T antigen staining is used as an indirect method to document the presence of BKVAN. There is an extremely important clinical value of kidney allograft C4d, interleukin-2 receptor and human leukocyte antigen DR detection in the diagnosis of BKVAN.

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