人微小病毒B19感染所致肝损害19例临床分析

Clinical features of patients with human parvovirus B19 infection:An analysis of 19 cases

目的探讨B19病毒感染所致肝损害的临床表现、实验室检查特点及治疗与转归。方法对人微小病毒B19感染患者19例的临床资料进行回顾性分析。结果在人微小病毒B19感染的19例患者,主要症状有乏力(12例)、黄疸(10例)、脾肿大(10例),伴有发热(10例)、皮疹(6例)及肌肉关节疼痛(6例),有6例伴有如下疾病或并发症:如妊娠(1例)、急性肝功能衰竭(2例)、精神分裂症(1例)、急性骨髓停滞(1例)和肺炎(1例)。以血清天门冬氨酸氨基转移梅(AST)升高为主,黄疸大多数表现为轻到中度,容易出现凝血酶原活动度(PTA)下降,但胆碱脂酶(CHE)下降不明显。经积极对症支持治疗,肝功能等各项指标正常后治愈出院。人微小病毒B19可致肝功能受损,导致急性肝炎或急性重型肝炎。结论对临床上非甲～戊型肝炎病人,应注意检查血清抗B19病毒IgM。该病毒感染是一个急性或亚急性过程,呈良性经过,有自愈倾向。

Objective To observe the clinical manifestation,laboratory examinations and therapy of patients with human parvovirus B19 infection.Methods 19 hospitalized patients in our hospital from August,2008 to July,2010 infected with human parvovirus B19 were investigated by clinical presentation,laboratory examinations and related therapy.Results The 19 hospitalized patients infected with human parvovirus B19 mainly presented symptoms with fatigue（12 cases）,jaundice（10 cases）,splenomegaly（10 cases）,fever（10 cases）,rash（6 cases）,myalgia and arthralgia（6 cases）.Six patients out of the 19 patients had following diseases or complications,such as pregnancy（1 case）,acute liver failure（2 cases）,schizophrenia（1 case）,acute myelosuppression（1 case） and pneumonia（1 case）.The characteristics of liver dysfunction showed elevated liver enzymes（AST/ALT）,mild or moderate jaundice,decreased PTA and normal CHE.The laboratory examinations in the 19 hospitalized patients with human parvovirus B19 infection were got back to normal and they all recovered after active symptomatic treatment（protecting liver function,decreasing liver enzymes,decreasing jaundice and administration of prednisolone and gamma globulin in some patients）.Conclusion Human parvovirus B19 is the only agent resulting in human diseases in Genus Parvovirus.The human parvovirus B19 can cause a series of clinical diseases including erythema infectiosum,natural abortion,myelosuppression and arthritis,etc.This article demonstrates that human parvovirus B19 is correlated with human hepatitis.Human parvovirus B19 might be an important pathogen for non hepatitis A to E.Human parvovirus B19 can results in hepatic lesion and cause acute hepatitis or acute fulminant hepatitis.It seemed that the hepatic lesion caused by human parvovirus B19 is an acute/subacute benign process and is prone to natural self-recovery.