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目的:探讨肾移植受者杀伤细胞免疫球蛋白样受体(KIR)基因多态性对肾移植术后微量巨细胞病毒(CMV)和BK病毒(BKV)DNA的影响。方法:采用序列特异性引物聚合酶链反应(PCR-SSP)法检测48例肾移植受者KIR基因多态性。依照不同功能的KIR单倍体,将KIR基因组合型分为抑制型KIR基因组合型(AA型)和非抑制型KIR基因组合型(BX型,包括BB型和AA型)。采用实时荧光定量PCR法检测肾移植术的受者血清DNA中CMV和BKV的载量。分析AA和BX KIR基因型对肾移植术后1年内CMV和BKV DNA血症累积阳性率及血肌酐的影响。结果:不同KIR基因型间,免疫抑制剂浓度无明显差异(P>0.05)。相较KIR-BX基因型,KIRAA基因型的BKV累积阳性率明显增加(P<0.05);而KIR两型间,CMV病毒血症的发生率没有明显差异(P>0.05)。KIR-AA型术后1~12月平均血肌酐水平较BX型低,差别有统计学意义(P<0.05);经3年随访,KIR-AA型受者血肌酐水平低于BX型(P<0.05),而2组间血尿素氮和尿酸水平无统计学意义。结论:KIR-AA基因型肾移植受者术后1年内BKV DNA血症增加,而不影响CMV DNA血症。
Objective: To investigate the effect of killer cell immunoglobulin-like receptor (KIR) gene polymorphism in kidney transplant recipients on cytomegalovirus (CMV) and BKV DNA after renal transplantation. Methods: The KIR gene polymorphisms of 48 renal transplant recipients were detected by PCR-SSP. KIR haplotypes were divided into KIR genotypes (AA type) and non-KIR genotype combinations (BX genotypes, including BB genotypes and AA genotypes) according to different functions of KIR haplotypes. Quantitative real-time PCR was used to detect the serum CMV and BKV levels in recipients of renal transplantation. The effect of AA and BX KIR genotypes on cumulative cumulative positive rate of CMV and BKV DNA and serum creatinine in renal transplant recipients within one year after renal transplantation was analyzed. Results: There was no significant difference in immunosuppressive concentrations between different KIR genotypes (P> 0.05). Compared with KIR-BX genotype, the positive rate of BKV accumulation in KIRAA genotype was significantly increased (P <0.05). However, there was no significant difference in the incidence of CMV viremia between KIR genotypes (P> 0.05). The average serum creatinine level in KIR-AA type was lower than that in BX type from January to December (P <0.05). After 3 years of follow-up, serum creatinine level in KIR-AA type was lower than that in BX type <0.05), while there was no significant difference between the two groups in blood urea nitrogen and uric acid levels. CONCLUSIONS: BKV DNA hyperlipidemia is increased within 1 year of KIR-AA genotype renal transplant recipients without affecting CMV DNA sepsis.