艾滋病合并人微小病毒B19感染导致纯红细胞再生障碍性贫血5例临床特征分析  

5 cases of clinical characteristics analysis about pure red blood cell aplastic anemia due to HIV co-infection with human microvirus B19

作　　者：许飞龙[1] 陈谐捷[1] 何凯茵[1] 谢志伟[1] 李青青 李凌华[1] XU Feilong;CHEN Xiejie;HE Kaiyin;XIE Zhiwei;LI Qingqing;LI Linghua(Department of Infectious Diseases,Guangzhou Eighth People's Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院感染病中心,广州510060

出　　处：《中国艾滋病性病》2021年第4期395-398,共4页Chinese Journal of Aids & STD

基　　金：广州市科技计划项目(202002020005)。

摘　　要：目的分析艾滋病合并人微小病毒B19(HPV B19)感染导致纯红细胞再生障碍性贫血临床特点。方法回顾性分析2018年6月至2019年12月在广州市第八人民医院住院部收治的5例艾滋病合并HPV B19感染导致纯红细胞再生障碍性贫血患者的临床资料。结果 5例艾滋病患者中,男性4例,年龄14~43岁;2例接受ART时间<1年,3例接受ART时间>3年,入院时:5例患者检测HIV RNA<20拷贝/mL,CD4细胞计数均<100个/mm^(3)。外周血HPV B19DNA(+),确证为HPV B19感染导致纯红细胞再生障碍性贫血。5例患者均应用静脉注射人免疫球蛋白及结合输注红细胞治疗,其中4例患者调整ART方案。历时2~10个月,4例患者CD4细胞计数>200个/mm^(3),外周血HPV B19DNA(-),贫血纠正;1例患者持续CD4细胞计数<100个/mm^(3)、血HPV B19 DNA(+),出现嗜血细胞综合征而死亡。结论 CD4细胞低下的艾滋病患者出现纯红细胞再生障碍性贫血,临床应怀疑并评估HPV B19感染,高效ART及良好的免疫重建是减少死亡的关键。Objective To analyze the clinical characteristics of pure red cell aplastic anemia caused by human parvovirus B19 infection in AIDS patients. Methods From June 2018 to December 2019, the clinical data of five AIDS patients with pure erythrocyte aplastic anemia caused by HPV B19 infection were analyzed retrospectively in Guangzhou Eighth People’s Hospital. Results Among the 5 AIDS patients, there were four males and one female, aged between 14-43 years, with two patients receiving ART for less than one year, and three patients for more than three years, and HIV RNA<20 copies/ml and CD4+T lymphocyte counts all less than 100/mm^(3) on admission to hospital. HPV B19 DNA was detected as positive in peripheral blood of the five patients, which confirmed that HPV B19 infection caused pure red cell aplastic anemia. The five patients were treated with intravenous injection of human immunoglobulin(IVIG) combined with red blood cell infusion, among which four adjusted ART regimen. After 2-10 months, CD4+T lymphocyte count of the four patients was more than 200/mm^(3), and HPV B19 DNA was negative in peripheral blood and anemia was corrected.However, one of the five patients had CD4+T lymphocyte count less than 100/mm^(3) all the time, blood HPV B19 DNA was positive, and at last died of hemophagocytic syndrome. Conclusion As AIDS patients with low CD4+T lymphocytes have pure red cell aplastic anemia, HPV B19 infection should be suspected and evaluated clinically. Effective ART and good immune reconstitution are the key to reduce death.

关 键 词：艾滋病 人微小病毒B19 纯红细胞再生障碍性贫血 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]