肝移植术后人类细小病毒B19感染的二代测序筛查及其相关危险因素分析  

Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors

作　　者：陈拓 李瑞东 应悦 陶一峰 沈丛欢 金嫣婷 王正昕 Chen Tuo;Li Ruidong;Ying Yue;Tao Yifeng;Shen Conghuan;Jin Yanting;Wang Zhengxin(Department of General Surgery,Liver Transplantation Center,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院普外科肝移植中心,上海200040 [2]复旦大学附属华山医院感染科,上海200040

出　　处：《器官移植》2019年第6期696-701,共6页Organ Transplantation

基　　金：国家自然科学基金面上项目(81873874、81773089);国家重大科技专项(2017ZX10203205)

摘　　要：目的总结肝移植术后人类细小病毒(HPV)B19感染的筛查方法并分析相关危险因素。方法回顾性分析86例受者的临床资料。根据二代测序(NGS)结果分为HPV B19感染组和对照组,分析HPV B19感染患者的临床特点、治疗方案及预后,采用单因素和多因素Logistic回归向前LR逐步法分析HPV B19感染的危险因素。结果86例受者中9例受者肝移植术后2周左右出现不明原因发热伴进行性贫血,NGS检测提示HPV B19阳性,诊断为HPV B19感染引起的纯红细胞再生障碍性贫血(PRCA)。所有患者给予静脉注射用免疫球蛋白(IVIG)治疗及免疫抑制方案调整后,血红蛋白水平明显回升。多因素分析结果显示,患者术后7 d外周血清球蛋白水平低[比值比(OR)=0.749,P=0.040]、年轻患者(OR=0.937,P=0.038)是肝移植术后HPV B19感染的独立危险因素。结论对于肝移植术后早期出现不明原因的血红蛋白水平下降的相对年轻患者,需考虑HPV B19感染。NGS筛查是早期诊断HPV B19感染的有效方法。患者术后7 d外周血清球蛋白水平低和年龄(年轻患者)可能是其发生的独立危险因素。Objective To summarize the screening methods for human parvovirus(HPV)1B9 infection after liver transplantation and analyze the related risk factors.M ethods Clinical data of 86 recipients were retrospectively analyzed.According to the results of next generation sequencing(NGS),lal recipients were divided into the HPV B19 infectio n group and control group.Clinical characteristics,treatment rgeime and clinical prognosis of patients infected with HP V B19 were analyzed.The risk factors of HPV B19 infection were analyzed using univariate and multivariate Logistic regression model by forward LR step method.Results Nine of the 86 recipients developed fever and progressive anemai with unexplained reasons at approximately 2 weeks after liver rtansplantation.NGS detection demonstrated that HPV B19 was positive and they were diagnosed with pure red cell aplasia(PRCA)caused by HPV B19 infection.After intravenous immunoglobulins(IVIG)was given and the immunosuppressant thearpy was adjusted,the hemoglobin levels in all patient were significantly increased.The results of multivariate analsyis revealed that low serum globulin level in peripheral blo od at postoperative 7 d[odds ratio(OR)=0.749,P=0.040]and young age(OR=0.937,P=0.038)were the independent risk factors of HPV B19 infection after liver transplantation.C onclusions HPV B19 infection should be considered in relatively young patients with unexplained hemoglobin decline aerly after liver transplantation.NGS screening is a n effective method for early diagnosis of HPV B19 infection.Lows erum globulin level in peripheral blood at postoperativ e 7 d and young age may be independent risk factors of the incidence of HPV B19 infection.

关 键 词：肝移植 人类细小病毒B19 纯红细胞再生障碍性贫血 二代测序 危险因素 感染 免疫排斥反应 心脏死亡器官捐献 静脉注射用免疫球蛋白 人类疱疹病毒 

分 类 号：R617[医药卫生—外科学] R619.3[医药卫生—临床医学]