先天性心脏病术后人细小病毒B19感染患儿的临床特征分析  

Clinical characteristics of human parvovirus B19 infection after congenital heart disease surgery

作　　者：胡燕 王春 郭予雄 王静 吴家兴 郑贵浪 孙跃玉 陈佩玲 刘晓冰[2] 温树生[2] HU Yan;WANG Chun;GUO Yu-xiong;WANG Jing;WU Jia-xing;ZHENG Gui-lang;SUN Yue-yu;CHEN Pei-ling;LIU Xiao-bing;WEN Shu-sheng(Department of Pediatric Intensive Care Unit,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Congenital Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangdong Provincial Key Laboratory of South China Structural Heart Diseases,Guangzhou 510080,China)

机构地区：[1]广东省人民医院(广东省医学科学院)儿科重症监护病房,广州510080 [2]广东省心血管病研究所小儿心脏外科广东省华南结构性心脏病重点实验室广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2021年第5期552-557,共6页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划(项目编号:2020YFC1107904);广东省医学科学技术研究基金项目(项目编号:A2021460)。

摘　　要：目的总结小儿先天性心脏病(congenital heart disease,CHD)术后人细小病毒B19(human parvovirus B19,HPV-B19)感染患儿的临床特点、治疗及转归。方法回顾性分析2019年6月至2021年6月广东省人民医院儿科重症监护室(pediatric intensive care unit,PICU)确诊的CHD术后HPV-B19感染患儿的临床表现、诊断及治疗。结果10例HPV-B19感染患儿中,男4例,女6例;年龄为0.84(0.3~9.0)岁;体质量为9.0(3.5~14.5)kg。10例患儿均出现发热,高热为主,无伴有明显中毒症状,同时伴发贫血突然加重。2例躯干弥漫充血性皮疹;4例轻度贫血,6例中度贫血;4例白细胞减少,2例粒细胞缺乏,1例粒细胞减少;5例血小板减少;1例血细胞三系减少;3例骨髓增生减低;3例单纯红系增生减低。于术后第12.8(7~23.0)天分别行定量聚合酶链反应(qPCR)检测呈阳性。9例给予静脉输注丙种球蛋白(intravenous injection of gamma globulin,IVIG)治疗,输注量466.7(300~700)mg·kg^(-1)·d^(-1),疗程2~5 d,另外1例仅需输注浓缩红细胞及对症治疗;8例应用IVIG后于第4.4(2~9)天(内热退,3例第4.3(2~7)天血小板恢复正常,4例第5.3(3~8)天白细胞恢复正常,4例第12.5(5~17)天血红蛋白逐渐恢复,5例应用IVIG前输注了浓缩红细胞血红蛋白无继续下降;8例第13.0(7~23)天动态检测HPV-B19病毒载量,7例应用IVIG后定量聚合酶链反应检测提示HPV-B19拷贝数下降,1例拷贝数降为0 copies/mL,1例应用IVIG前检测提示拷贝数仍升高。治愈出院9例,1例死于心源性休克。结论小儿CHD术后早期不明原因发热伴白细胞减少、贫血加重者,应警惕感染HPV-B19;确诊后尽早使用IVIG有助于促进康复。Objectives To summarize the clinical characteristics,treatment and prognosis of human parvovirus B19(HPV-B19)infection in children with congenital heart disease(CHD)after operation.Methods To retrospectively analyze the clinical manifestations,diagnosis and treatment of children with HPV-B19 infection after CHD operation in pediatric intensive care unit(PICU)of Guangdong Provincial People′s Hospital from June 2019 to June 2021.Results Among the 10 children with HPV-B19 infection,4 were males and 6 were females,aged 0.84(0.3-9.0)years;weighed 9.0(3.5-14.5)kg.All the 10 children developed fever,mainly hyperpyrexia,without obvious poisoning symptoms,accompanied by sudden aggravation of anemia.Two cases were with diffuse congestive rash of trunk;4 cases were with mild anemia and 6 cases were with moderate anemia;4 cases were with leukopenia,2 cases were with agranulocytosis and 1 case was with granulocytopenia;5 cases were with yhrombocytopenia;1 case were with pancytopenia;3 cases were with bone marrow hyperplasia decreasing;3 cases were with erythroid hyperplasia decreasing.The positive reaction was detected by quantitative polymerase chain reaction(qPCR)respectively for 12.8(7-23.0)d after operation.Nine cases received intravenous injection of gamma globulin(IVIG)at an infusion volume of 466.7(300-700)mg·kg^(-1)·d^(-1) for 2-5 days,and the other patient only needed transfusion of concentrated red blood cells and symptomatic treatment.The fever decreased within 4.4(2-9)days in 8 cases after the treatment of IVIG.Platelets returned to normal in 3 cases for 4.3(2-7)days,white blood cells returned to normal in 4 cases for 5.3(3-8)days,hemoglobin gradually recovered in 4 cases for 12.5(5-17)days.There was no further decreasing in hemoglobin after infusion of concentrated red blood cells in 5 cases before the use of IVIG.The HPV-B19 viral load was dynamically detected in 8 cases for 13.0(7-23)d.qPCR analysis showed that the copy number of HPV-B19 decreased in 7 cases after the application of IVIG,decreased to 0 copi

关 键 词：先天性心脏病 病毒 人细小病毒B19 感染 

分 类 号：R541.7[医药卫生—心血管疾病]