Status on the diagnosis and treatment of BK virus infection

doi:10.3969/j.issn.1673-8640.2017.05.021

Abstract

Abstract:

：BK virus （BKV） belongs to a subtype of human polyomavirus. Recessive infection rate of BKV in general population is about 80%. With expanded use of organ transplantation in recent years where strong immunosuppression is essential,BKV associated nephropathy（BKVAN）,hemorrhagic cystitis,ureterostenosis and other associated diseases due to the reactivation of latent BKV in immunosuppressed or immunocompromised populations are becoming more of a concern in medical community. Since the prevention measures and effective antiviral drugs for BKV are rather limited,the effective means for reducing BK associated morbidity and mortality due to BKV associated diseases are the early monitoring of viral loads,reducing the usage of immunosuppressant,adjusting immunosuppressant treatment regime and using adjuvant therapies. This review describes the clinical symptoms,biology,mechanisms and the advances in the diagnosis and treatment of BKV at home and abroad.

Key words: BK virus, BK virus associated nephropathy, Virus detection, Diagnosis, Treatment

CLC Number:

R446.5

ZHANG Zhigang, CAO Lu, WANG Xin, ZHAO Qinjian. Status on the diagnosis and treatment of BK virus infection[J]. Laboratory Medicine, 2017, 32(5): 440-445.

Figures/Tables 3

References 33

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检测和诊断方法	优点	缺点	临床应用情况
基于尿液Decoy 细胞检测	敏感性、阴性预测值均较高（>99%）	阳性预测值较低（25%~30%）	用于器官移植后BKV感染的筛查
基于电镜的 Haufen检测	阳性预测值、阴性预测值均较高（>90%）	未经大规模临床试验证实	作为候选的BKVAN非侵入性诊断方法
基于VP1 mRNA 的分子检测	敏感性、特异性均高（>90%）	成本较高,操作难度大,样本预处理较难	辅助监测体内BKV复制程度
定量PCR	敏感性100%,特异性88%~98%	尚无统一的病毒临界载量标准	作为肾移植后BKV监测的首选方法
肾组织活检	阳性预测值100%	有创性检查,容易出现假阴性的检测结果	作为诊断BKVAN的金标准

检测和诊断方法	优点	缺点	临床应用情况
基于尿液Decoy 细胞检测	敏感性、阴性预测值均较高（>99%）	阳性预测值较低（25%~30%）	用于器官移植后BKV感染的筛查
基于电镜的 Haufen检测	阳性预测值、阴性预测值均较高（>90%）	未经大规模临床试验证实	作为候选的BKVAN非侵入性诊断方法
基于VP1 mRNA 的分子检测	敏感性、特异性均高（>90%）	成本较高,操作难度大,样本预处理较难	辅助监测体内BKV复制程度
定量PCR	敏感性100%,特异性88%~98%	尚无统一的病毒临界载量标准	作为肾移植后BKV监测的首选方法
肾组织活检	阳性预测值100%	有创性检查,容易出现假阴性的检测结果	作为诊断BKVAN的金标准