肝移植后人细小病毒B19感染导致单纯红细胞再生障碍性贫血一例  

Diagnosis and treatment of pure red cell aplasia caused by human parvovirus B19 after liver transplantation： Report of one case and literature review

作　　者：任庆旗[1] 鞠卫强[1] 王东平[1] 郭志勇[1] 陈茂根[1] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院器官移植中心广东省器官捐献与移植免疫重点实验室广东省器官移植国际科技合作基地,广州510080

出　　处：《中华器官移植杂志》2016年第3期144-149,共6页Chinese Journal of Organ Transplantation

基　　金：广东省器官捐献与移植免疫重点实验室建设项目（2013A061401007）;公益性行业科研专项基金（201302009）;广东省器官移植国际合作基地建设项目（201513050501002）

摘　　要：目的探讨肝移植受者人细小病毒B19（HPVB19）感染致单纯红细胞再生障碍性贫血（PRCA）的诊断和治疗方法。方法回顾性分析1例肝移植术后HPVB19感染致PRCA的临床表现、诊断和治疗过程，并复习相关文献。结果确诊为HPVB19感染所致PRCA的肝移植受者，其临床表现为头晕、乏力、气促等贫血症状，血常规表现为进行性红细胞、网织红细胞和血红蛋白降低，骨髓涂片提示红细胞系细胞缺如，血HPVB19DNA阳性。抗排斥反应方案由他克莫司＋西罗莫司更改为环孢素A＋西罗莫司后，患者红细胞、网织红细胞和血红蛋白恢复至正常水平，血HPVB19 DNA低于检测下限（1×10^3拷贝／ml），骨髓涂片提示正常骨髓片。后患者血肌酐升高，抗排斥反应方案恢复为他克莫司＋西罗莫司后再次出现血HPVB19DNA阳性，而患者网织红细胞保持正常水平，无PRCA复发表现。术后第468天，患者因肺部感染进展死于多器官功能衰竭。结论对于肝移植受者HPVB19感染致PRcA的病例，可行HPVB19DNA检测以明确诊断，免疫抑制药物转换在治疗中有重要作用。Objective To investigate the diagnosis and treatment of pure red cell aplasia （PRCA） caused by human parvovirus BI9 （HPVB19） after liver transplantation. Method The clinical data of one case of PRCA caused by HPVB19 after liver transplantation, including clinical manifestations, diagnosis and treatment, were retrospectively analyzed, and the related literatures were reviewed. Result The first case of PRCA caused by HPVB19 after liver transplantation in our center with typical clinical manifestations of anemia was diagnosed, including dizziness, fatigue, anhelation and so on. A progressive decrease in erythrocyte count, reticulocyte count and hemoglobin level were observed by blood routine test. Bone marrow aspiration biopsy showed an absence of erythroid cells and the HPVB19 DNA test of blood was positive. Erythrocyte count, reticulocyte count and hemoglobin level were back to normal after the anti-rejection strategy changing from tacrolimus and rapamycin to cyclosporin and rapamycin and a normal human myelogram was observed by bone marrow aspiration biopsy. The DNA concentration of HPVB19 in blood was below the lower test limit. The blood test of HPVB19 DNA showed a positive result again after the anti-rejection strategy changed back to tacrolimus and rapamycin duo to increased blood creatinine level while the reticulocyte count was still in normal scale. This is the first reported ease of successfully cured PRCA caused by HPVB19 in liver transplantation patients through changing the anti-rejection strategy and also the first case of HPVB19 re-infection or relapse without PRCA recurrence in liver transplantation patients. Conclusion This case may indicate the importance of imrnunosuppressive drug changing inthe treatment of liver recipients suffering from PRCA caused by HPVB19 infection, and the genotype test may promote the understanding and treatment for this disease.

关 键 词：细小病毒B19 人 红细胞再生障碍 纯 肝移植 免疫抑制剂 

分 类 号：R556.5[医药卫生—血液循环系统疾病]