肾移植术后供者来源性人细小病毒B19感染导致纯红细胞再生障碍性贫血的分析与探讨  

Analysis and investigation of donor-derived human parvovirus B19 infection related pure red cell aplasia in renal transplant recipients

作　　者：张健[1] 田野[1] 王强[1] 唐雅望[1] 郭宇文[1] 孙雯[1] 张磊[1] 朱一辰[1] 王志鹏[1] 杨洋 丁光璞 林俊[1] ZHANG Jian;TIAN Ye;WANG Qiang(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing,100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《临床和实验医学杂志》2022年第5期461-464,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市自然科学基金面上项目(编号:7192043);国家自然科学基金面上项目(编号:82070765)。

摘　　要：目的探讨肾移植术后供者来源性人细小病毒B19(HPV-B19)感染的防治策略。方法回顾性分析2019年1月至2021年8月首都医科大学附属北京友谊医院收治的6例肾移植术后早期高度怀疑供者来源性HPV-B19感染导致纯红细胞再生障碍性贫血(PRCA)患者的临床诊治经过。结果6例(3对)患者肾脏分别来源于同一供者。患者均于移植后早期出现严重贫血,HPV-B19 DNA检测阳性,骨髓穿刺确诊为PRCA。6例患者均接受输血治疗,在调整免疫抑制方案或剂量的同时,使用大剂量静脉注射免疫球蛋白(IVIG)(总剂量1.5~2.0 g/kg)。6例患者贫血均得到明显改善,网织红细胞计数出现逆转性升高为PRCA改善的最早表现。治疗期间所有患者肾功能稳定,未发生明显不良反应。随访过程中,6例患者病情平稳,HPV-B19 DNA仍持续阳性(低水平),IgG抗体持续阴性。4例患者随访超过1年,IgM抗体转为阴性,转阴时间为10~12个月,其余患者IgM抗体仍为阳性。结论肾移植术后严重的HPV-B19感染可导致PRCA,及时采取治疗措施安全有效。鉴于移植后早期HPV-B19感染存在供者来源可能性,建议供者捐献前筛查HPV-B19。对于阳性供者,其器官经移植后应严密监测受者感染情况并及时采取防治措施。Objective To investigate prevention and treatment strategy of donor-derived human parvovirus B19(HPV-B19)infection after renal transplantation.Methods The clinical courses of six patients with suspiciously donor transmitted HPV-B19 infection related pure red cell aplasia(PRCA)early after renal transplantation in Beijing Friendship Hospital,Capital Medical University between Jan 2019 and Aug 2021 were retrospectively analyzed.Results Among six patients(three pairs),each pair's kidneys were from the same donor.Severe anemia occurred in all patients early after transplantation.HPV-B19 DNA detection was positive and PRCA was confirmed by bone marrow biopsy.All patients received blood transfusion.While adjusting the immunosuppressive regimen or dose,patients received intravenous immunoglobulin(IVIG)with a total dose of 1.5-2.0 g/kg.Anemia was significantly improved in all six patients,and the reverse increase of reticulocyte count was the earliest manifestation of PRCA improvement.All patients had stable renal function without obvious adverse reactions.During follow up,all patients were in stable condition,while HPV-B19 DNA was still positive with low level.IgG antibody was persistently negative.Four patients were followed up for more than one year and IgM antibody turned negative at 10 to 12 months.IgM antibody of the rest was still positive.Conclusion Severe HPV-B19 infection can lead to PRCA after renal transplantation and timely treatment is safe and effective.Given the possibility of donor transmission of HPV-B19 infection early after transplantation,HPV-B19 screening is recommended for donors before organ donation.Recipients who received organs from donor with HPV-B19 infection should be closely monitored for HPV-B19 in order to receive timely prevention and treatment.

关 键 词：肾移植 人细小病毒B19 纯红细胞再生障碍性贫血 供者传播 防治策略 

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