肾移植后微小病毒B19感染导致纯红细胞再生障碍性贫血八例

Pure red cell apalsia caused by infection of human parvovirns B19 post-renal transplantation： 8 casesreport and review

目的探讨肾移植后微小病毒B19感染导致的纯红细胞再生障碍性贫血（PRCA）的诊断及其治疗。方法2011年8月至2012年3月间共诊断肾移植后微小病毒B19感染导致的PRCA患者8例。采用转换免疫抑制剂、输注丙种球蛋白、加大激素用量、停用骨髓抑制药物及必要时联合膦甲酸钠抗病毒等综合措施进行治疗。在治疗前后对其临床表现、实验室检查、病理检查、转归等进行回顾与总结分析。结果8例初次诊断时间为移植后（53±15）d（32-86d），期间肾功能稳定。治疗前血红蛋白最低值为（58±9．3）g／L（50-73g／L），综合治疗后所有患者均治愈，治疗起效时间为（22±13）d（8-47d），治疗后1个月和3个月的血红蛋白分别为（106．8±22．3）g／L和（116．0±20．7）g／L。患者随访（222±93）d，血红蛋白水平稳定。结论对肾移植后微小病毒B19感染导致的PRCA，采用转换免疫抑制剂、输注丙种球蛋白、加大激素用量、停用骨髓抑制药物，必要时联合应用膦甲酸钠抗病毒等综合措施治疗有效。

Objective To investigate the clinical features, diagnosis and treatment of pure redcell aplasia cased by human parvovirus B19 infection after renal transplantation. Method The clinical data including clinical symptoms and physical signs, laboratory and pathological examinations and outcomes of treatment in 8 cases at our hospital from Aug. 2011 to Mar. 2012 were analyzed retrospective, and relative literatures were reviewd. Result Pure red-cell aplasia occurred in all 8 cases 1 to 3 months after kidney transplantation, and one case had recurremt pure red-cell aplasia. The manifestations including recurrent reduction of hemoglobin, and pure red-cell aplasia was definitely diagnosed by bone marrow morphology, pathology, and polymerase chain reaction assay PVB19 DNA. Treatment of intravenous immunoglobulin and conversion of tacrolimus into ciclosporin was effective. Conclusion PVB19 is a rare but clinically significant infection that manifests as pure red cell aplasia during the early post-transplantatiolx Treatment of intravenous immunoglobulin and conversion of tacrolimus into ciclosporin in most cases was effective.