Objective To analyzed predictive value of urine cytology for the development of BK viremia and its possible advantage for the early BKVAN prediction.Methods Periodic urine and serum samples obtained from 129 renal transplant patients were analyzed for BKV positivity by urine cytology and real-time polymerase chain reaction.The detective results were compared and analyzed.Results Decoy cells were found in 439 samples from 25 ( 19％ ) patients; viral DNA was amplified in 8 (6％) patients,serum samples.BKVN was identified in 3 (2％) patients,all from the group with decoy cell excretion.Urine cyto-logy show sensitivity of 100％ and specificity of 83％ for BKAVN.Interestingly,BK viremia was preceded by BK viruria.Conclusion Urine cytology screening for decoy cell is a reliable marker allowing an early identi-fication of patients at high risk of BKVAN development and therefore assures precocious therapeutic interventions.%目的 探讨尿液细胞学检查在肾移植患者BK病毒感染筛选和监测中的价值.方法 定期收集2006年1月至2008年12月间129例肾移植患者的尿液标本查找诱饵细胞( decoy cell).对decoy细胞阳性者(病毒尿症)聚合酶链反应方法检测预留的血液标本的BK病毒DNA并随访.血肌酐升高及持续性病毒血症、病毒尿症者进行移植肾穿刺活组织检查.对检测结果进行分析评价.结果 25例(19％)患者的439份尿液标本检查到decoy细胞,首次检测到decoy 细胞的中位时间为移植后69(14 ～540)d;8例(6％)患者存在病毒血症,最早出现在移植后119(56～ 540)d.3例(2％)患者病理证实存在多瘤病毒性肾炎,全部来自持续性decoy细胞阳性组患者且存在病毒血症.最早检测到decoy细胞时间比病毒血症(52 d)和病理诊断(81 d)分别提前.decoy细胞检测预警多瘤病毒性肾炎的敏感度为100％,特异性为83％,阳性预测值为12％,阴性预测值为100％.结论 尿液细胞学检查寻找decoy细胞是一项简单、敏感的筛选、监测BK感染的工具,和病毒血症相比能更早的提示BK病毒感染.
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