BK病毒感染對腎臟移植病患腎功能影響之探討

Relationships between infection of BK virus and renal functions in kidney transplant recipients

謝明昌(Ming-Chang Hsieh)

指導教授 ： 邱慧玲

中山醫學大學/醫學院/生化暨生物科技研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00108

摘要

臺灣因末期腎衰竭而接受血液透析或腹膜透析的人數有逐年增加的趨勢，為了解決透析所帶來的生活上的不方便，腎臟移植被認為是最好的腎臟替代療法。但在腎臟移植成功後，患者仍需面對移植所帶來的不同併發症，其中BK病毒（BKV）感染可能引起移植腎臟的間質性腎炎，進而導致腎臟功能受損或喪失，是造成移植腎臟功能損壞的重要原因之一，因此BKV的檢測對於腎臟移植的患者極為重要。為了能夠儘早偵測出BKV，本研究以PCR方法進行250名腎臟移植患者的尿液檢體篩檢。結果顯示未出現病毒感染的病患有119名，有35名(14%)病患的尿液出現BKV；出現JC病毒的有80名，另外同時出現BKV及JCV的病患有16名(6.4%)。進一步的腎功能相關因子相關性探討發現，BKV感染對於腎臟移植患者的血清creatinine濃度有顯著的影響；出現BKV感染病患的血清creatinine濃度為1.39 ± 0.09 (mg/dl)，明顯高於未出現病毒感染病患的1.21 ± 0.03，此差異具有統計學上意義(P < 0.05)；尿液中出現BKV的患者的尿液細胞學檢測也觀察到Decoy cells的存在，證實此項PCR檢測結果的正確性。另外有6位病患的血液病毒檢測結果為陽性，其中兩名患者的腎臟組織切片送往檢查，也觀察到腎臟病變的發生。因此直接由病患的尿液檢體中作檢測，對於腎臟移植患者有很大的幫助，可以儘早提供給臨床醫師作參考，給予患者適當的免疫抑制劑作治療，以減少因BKV感染導致移植腎臟功能損壞的結果。

關鍵字

BK病毒 ； 腎臟移植 ； 腎功能

並列摘要

The number of end stage renal failure patients receiving hemodialysis or peritoneal dialysis has been continuously increased annually. Among various treatment options, kidney transplantation is considered to be the first choice based on its advantage of convenience over the traditional dialysis. However, kidney transplantation may lead to some complications, including BK virus infection which may cause nephritis of the donated kidney and eventually dysfunction and transplation failure. Therefore the early detection of BKV may be beneficial for the kidney transplant recipients. To achieve that, DNA samples extracted urine samples of 250 kidney transplant recipients were subjected to a direct PCR analysis. Results showed that 119 patients were negative for viral infection while BKV was detected in 35 patients (14%) and JCV was detected in 80 patients with 16 patients (6.4%) were coinfected by BKV and JCV. The relationships between viral infection and renal functions were analyzed to show that BKV has significant effects on serum creatinineconcentration since the average of serum creatinine concentration of BKV infected patients is 1.39 ± 0.09 (mg/dl), which was significantly higher than 1.21 ± 0.03 of patients not infected (P<0.05). Urine samples positive for BKV were then subjected to cytological examination to reveal the presence of Decoy cells. Furthermore, among 6 BKV-infected patients whose blood samples were positive for BKV, 2 patients were subjected to kidney biopsy examination and the presence of kidney disease was confirmed. Taken together, these results suggested that the PCR monitoring of BKV with urine samples is a quick, invasive and beneficial way for the long-term care of kidney transplant recipients.

並列關鍵字

BK virus ； kidney transplant ； renal function

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