微小病毒B19感染致肾移植后纯红细胞再生障碍性贫血诊疗分析5例  

Diagnosis and treatment of pure red cell aplasia caused by human parvovirus B19 （HPV B19） infection after renal transplantation （report of 5 cases）

作　　者：陈栋[1] 魏来[1] 蒋继贫[1] 冯锦城 李军[1] 卢峡[1] 明长生[1] 陈知水[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,武汉430030

出　　处：《中华器官移植杂志》2015年第9期520-522,共3页Chinese Journal of Organ Transplantation

摘　　要：目的回顾并总结微小病毒B19（HPV—B19）感染所致的肾移植后纯红细胞再生障碍性贫血（PRCA）的诊断和治疗。方法以顽固性贫血的5例肾移植患者为对象，均应用他克莫司、吗替麦考酚酯和甲泼尼龙的免疫抑制方案，排除出血、溶血等情况，骨髓细胞学检查提示出现典型PRCA表现，血清微小病毒B19IgM检测为阳性。治疗上予以停用吗替麦考酚酯，并予静脉注射用丙种球蛋白（IVIG）20g／d，共5～7d，应用蔗糖铁注射液100mg／d，维生素B12500μg／d，促红细胞生成素10000U／d。结果全部病例治疗1个月后，贫血得以纠正，未见复发。结论肾移植后出现顽固性贫血的患者应考虑HPVB19感染所致的PRCA，针对性治疗后效果良好。Objective To analyze and summarize the diagnosis and treatment of pure red cell aplasia （PRCA） caused by human parvovirus B19 （HPV B19） infection after renal transplantation. Method Five kidney transplantation receipts with refractory anemia were excluded from hemorrhage and hemolytic anemia, and the immunosuppressive regimen was tacrolimus, mycophenolate mofetil and methylprednisolon. Bone marrow aspirate showed the classic morphological changes of PRCA, and parvovirus B19 was demonstrated IgM antibodies in the blood. Mycophenolate mofetil was discontinued once the PRCA was diagnosed, and high dose intravenous immunoglobulin （20 g/day） was given in combination with erythropoietin （10 000 U/day, vitamin B12 500 mg/day and iron sucrose 100 mg/day）. Result After treatment for 1 month, anemia was corrected, and no recurrence occurred. Conclusion The HPV B19-induced PRCA should be considered in the patients with refractory anemia after renal transplantation. The individualized treatment can obtain satisfactory outcome.

关 键 词：肾移植 细小病毒B19 人 红细胞再生障碍 纯 

分 类 号：R699.2[医药卫生—泌尿科学] R556.5[医药卫生—外科学]