肾移植术后微小病毒B19V感染与相关贫血的临床特点分析  

The analysis for clinical characteristics of human parvovirus B19 infection and associated anemia after kidney transplantation

作　　者：赖柳生 何佳佳 刘伟 晏强 Lai Liusheng;He Jiajia;Liu Wei;Yan Qiang(The 924th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Military Organ Transplantation and Dialysis Treatment Center,Guangxi Guilin 541002,China)

机构地区：[1]中国人民解放军联勤保障部队第九二四医院,全军器官移植与透析治疗中心,广西桂林541002

出　　处：《实用器官移植电子杂志》2024年第4期310-314,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：广西自然科学基金项目(2017GXNSFAA198185);2022年桂林市技术应用与推广计划(20220139-1-1)。

摘　　要：目的探讨肾移植术后受者人微小病毒B19(human parvovirus B19,B19V)感染所致贫血的临床特点及其治疗方案。方法以在中国人民解放军联勤保障部队第九二四医院器官移植中心接受同种异体肾移植手术的5例受者术后出现顽固性贫血为观察对象,实验室检查均为小细胞低色素性贫血,在排除常见贫血原因后,血液宏基因二代测序(metagenomic next-generation sequencing,mNGS)检测人微小病毒B19V阳性,给予患者促红素、口服铁剂、静脉注射人免疫球蛋白(400 mg/kg,第1~5天)、调整免疫抑制方案(他克莫司部分减量,部分调整他克莫司为环孢素)等综合治疗。结果在5例患者中,经综合治疗后,4例(80%)患者病情得到明显缓解,1例出现复发,经再次静脉注射人免疫球蛋白后好转,治疗期间1例合并急性排斥反应。结论肾移植术后对于出现不明原因贫血且进行性加重的患者,应警惕人微小病毒B19V感染的可能。规范疗程静脉注射人免疫球蛋白是肾移植术后人微小病毒B19V感染导致纯红细胞再生障碍性贫血的首选治疗方法,对于复发患者,再次应用仍然有效。联合调整免疫抑制剂方案等综合治疗,可获得理想疗效。同时在治疗期间还需密切监测移植肾功能状态,防止出现移植肾排斥反应。Objective To investigate the clinical characteristics and treatment plans of anemia caused by human parvovirus B19V infection after kidney transplantation.Methods A total number of 5 patients with refractory anemia who underwent kidney transplantation surgery at the Organ Transplantation Center of the 924th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China were observed.Laboratory tests showed small cell hypochromic anemia,and after ruling out common causes of anemia,blood metagenomic next-generation sequencing(mNGS)testing showed positive for human parvovirus B19V.Treatment included erythropoietin,oral iron,intravenous injection of human immunoglobulin(400 mg/kg,d 1~5),adjusting the immunosuppressive regimen(partially reducing the dose of tacrolimus,partially adjusting tacrolimus to cyclosporine)and other comprehensive treatments.Results After comprehensive treatment,4 cases among the 5 patients(80%)showed significant improvement in their conditions,1 case experienced recurrence,which was improved after intravenous injection of human immunoglobulin again.During treatment,1 case developed acute rejection reaction.Conclusion After kidney transplantation,patients with unexplained anemia and progressive exacerbation should be alert to the possibility of human parvovirus B19V infection.Intravenous injection of human immunoglobulin is the preferred treatment method for pure red blood cell aplastic anemia caused by human parvovirus B19V infection after kidney transplantation.For recurrent patients,reapplication is still effective.Combined adjustment of immunosuppressive regimens and other comprehensive treatments can achieve ideal therapeutic effects.During the treatment period,it is also necessary to closely monitor the functional status of the transplanted kidney to prevent rejection reactions.

关 键 词：人微小病毒B19V 肾移植 纯红细胞再生障碍性贫血 静注人免疫球蛋白 

分 类 号：R699.2[医药卫生—泌尿科学] R619.3[医药卫生—外科学]