| 李帅阳 沈兵 刘志宏 秦燕 龚华 谈鸣岳 邱建新 包尔敦 范昱.肾移植术后人微小病毒B19 感染导致纯红细胞增生障碍性贫血[J].,2012,12(14):2698-2702 |
| 肾移植术后人微小病毒B19 感染导致纯红细胞增生障碍性贫血 |
| Human Parvovirus B19-induced Pure Red Cell Aplasia In PatientsWith Allograft Renal Transplantation |
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| DOI： |
| 中文关键词: 肾移植 人微小病毒B19 纯红细胞再生障碍性贫血 免疫球蛋白 |
| 英文关键词: Renal transplantation Human Parvovirus B19 Pure red cell aplasia Intravenous immunoglobulin |
| 基金项目:卫生部国际交流与合作中心科研项目（IHECC07-001）;
上海市卫生局器官移植临床医学中心内部课题（QY040101-2-12） |
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| 中文摘要: |
| 目的：探讨肾移植术后人微小病毒B19 感染所致纯红细胞再生障碍性贫血的诊断及其治疗。方法：回顾性分析4 例肾移植
术后纯红细胞再生障碍性贫血患者的临床特点，诊断方法，治疗过程及预后。结果：两周内在本中心接受肾移植手术的6 例患者
中，有4 例在术后60 天内均出现发热、血红蛋白进行性下降等相似症状；综合骨髓穿刺、ELISA 方法检测血清特异性IgG、IgM 等
方法诊断为人微小病毒B19 感染；经静脉注射免疫球蛋白、调整免疫抑制方案等综合治疗后，4 例患者病情均明显缓解。结论：(1)
贫血是肾移植术后患者感染人微小病毒B19 的典型临床症状；(2)PCR 检测和/ 或ELISA 方法，结合骨髓穿刺及其他实验室指标
可诊断人微小病毒感染；（3）静脉注射免疫球蛋白是肾移植术后人微小病毒B19 感染导致PRCA 的首选治疗方法，病情反复时，
再次应用仍然有效。同时予以调整免疫抑制剂方案等综合治疗，可获得理想疗效。 |
| 英文摘要: |
| Objective: Explore the diagnosis and treatment of pure red cell aplasia (PRCA) induced by human parvovirus B19 in
patients with allograft renal transplantation. Methods：4 cases of allograft renal transplantation patients suffered from HPV-B19 infection
with the symptom of PRCA were analyzed retrospectively of the clinical features, diagnostic methods, treatment process and prognosis.
These 4 cases who received several courses Intravenous immunoglobulin (IVIG) were cured finally and followed-up for 24 months.
Results：(1) The 4 of 6 renal transplant recipients in our center appears highly similar clinical symptoms such as fever, gradually
hemoglobin (Hb) decreasing within 60 days post-transplantation; (2) 4 cases of HPV-B19 infection were confirmed by
anti-HPV-B19-IgM/IgG examination, bone marrow aspiration and other laboratory examinations, combined with epidemiological
characteristics; (3) HPV-B19-associated PRCA can be cured by IVIG and adjusted baseline immunosuppression regimen, and may be
recurrent in these immunocompromised patients, and the following course of IVIG would be still effective. Conclusion： (1) Anemia is a
prominent clinical symptoms in patients after renal transplantation infected with HPV-B19, HPV-B19 infection should be suspected for
such patients with unaccountability anemia; (2) PCR technology and/or specific IgM/IgG examination, bone marrow aspiration, and
other laboratory examines will meet the requirements of HPV-B19 diagnosis;（
3）IVIG is recommended as first regimen to control the
serious HPV-B19 infection-associated PRCA in patients with renal allograft transplantation, while baseline immunosuppression regimen
should be carefully adjusted and lowered to reduce relapse probability. |
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