肾移植受者BK病毒感染的电镜超微病理观察
李 森，许钰铃，王佳荣，李佩瑶，何春雨，于希平，李慧艳，张宇程，胡怀斌，宋增庆，王 凯，韩秋影，涂海情*肾移植受者BK病毒感染的电镜超微病理观察
王 惠，徐 进，王素霞*
（北京大学第一医院电镜室暨超微病理诊断和研究中心，北京100034）
摘 要 BK病毒相关性肾病是BK病毒在肾组织内激活和大量复制而导致肾小管间质损害为主的肾病，该病是影响肾移植患者远期生存和移植肾功能丧失的重要因素。尿液Decoy细胞的检测是临床上诊断BK病毒感染的无创检查手段之一，以往研究多集中在尿液中病毒DNA的检测以及尿液Decoy细胞的光镜观察，而对Decoy细胞的超微结构研究报道较少。肾活检组织的电镜检查在受感染的肾小管上皮细胞内观察到BK病毒颗粒是诊断BK病毒相关性肾病的方法之一。本研究通过透射电镜观察了尿液Decoy细胞和肾组织内BK病毒的超微结构特征。BK病毒直径30~40 nm、大小均一、核心呈中高电子密度、无包膜，呈微晶矩阵或松散集落排列。本研究显示，透射电镜观察BK病毒相关性肾病患者尿沉渣中Decoy细胞的BK病毒检出率高于肾活检组织(由于肾活检取材有限)。尿沉查电镜检查是一种无创的、可重复的检查方法，对于移植肾BK病毒感染的诊断及其动态监测均具有重要作用。
关键词 移植肾；尿沉渣；Decoy细胞；BK病毒；电镜检查；超微病理
中图分类号：R373；Q336 文献标识码：A doi:10.3969/j.issn.1000-6281.2023.01.001
Electron microscopic observation of BK virus infection in recipients of transplanted kidney
WANG Hui，XU Jin，WANG Su-xia *
（Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, China）
Abstract The reactivation and replication of BK polyoma virus (BKV) in renal epithelial cells can lead to kidney injury, which is diagnosed as BK virus associated nephropathy (BKVAN), and is increasingly recognized as the common cause of renal graft loss, and affects the long-term survival of kidney transplantation recipients. The detection of urinary “Decoy cells” is a non-invasive method to screen the infection of BKV in allograft kidneys. Previous studies mainly focused on the detection of BK virus DNA by PCR technique and the light microscopic observation of Decoy cells in urine, the electron microscopic observation of urine Decoy cells has been rarely reported. The electron microscopy of renal biopsy specimens can identify the BK virus particles in the affected renal tubular epithelium, which is regarded as one the method to diagnose BKVAN. In this study, the ultrastructural characteristics of BK virus in urinary Decoy cells and kidney biopsy tissue were observed by transmission electron microscope (EM). The viral particles appeared as 30~40 nm, non-enveloped particles, often arranged in loose cluster arrangement and paracrystalline arrays. Under EM, the detection rate of Decoy cells in urine sediment is higher than that of renal biopsy tissue in BKVAN (due to limited renal biopsy) from this study. The detection of Decoy cells in urine sediments by EM is a non-invasive and valuable method of BKVAN, which plays an important role in the diagnosis and monitoring progression of BK virus infection in recipients of transplanted kidney.
Keywords allograft kidney; urine sediment; Decoy cells; BK polyoma virus; electron microscopy; ultrastructural pathology
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