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 Patients With Allograft Renal Transplantation

作　　者：李帅阳[1] 沈兵[1] 刘志宏[1] 秦燕[1] 龚华[1] 谈鸣岳[1] 邱建新[1] 包尔敦[1] 范昱[1] 

机构地区：[1]上海交通大学附属第一人民医院移植泌尿外科,上海200080

出　　处：《现代生物医学进展》2012年第14期2698-2702,共5页Progress in Modern Biomedicine

基　　金：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)

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。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.

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 

分 类 号：R617[医药卫生—外科学] R556.5[医药卫生—临床医学]