肾移植术后人类微小病毒B19感染致纯红细胞再生障碍性贫血2例并文献复习

Pure red cell aplasia caused by human parvovirus B19 infection after renal transplantation: a report of 2 cases and literature review

目的探讨肾移植术后人类微小病毒(HPV)B19感染致纯红细胞再生障碍性贫血(纯红再障)的诊断和治疗特点。方法总结南方医科大学南方医院器官移植科收治的2例肾移植术后HPV B19感染致纯红再障的病例,结合文献复习讨论该病的临床特点、诊断方法、治疗过程及预后。结果两例肾移植受者术后早发严重贫血且进行性加重,输血治疗无效。排除导致贫血的其他原因,综合骨髓穿刺活检、荧光聚合酶链反应(PCR)检测HPV DNA等方法诊断为HPV B19感染致纯红再障。经调整免疫抑制方案、静脉注射用免疫球蛋白(IVIG)等治疗后2例患者贫血症状明显改善。结论对于肾移植术后早期不明原因、进行性加重的贫血患者,特别是伴随网织红细胞缺乏者,应考虑HPV B19感染致纯红再障的可能性。骨髓穿刺及荧光PCR检测结果是诊断纯红再障的主要依据,免疫抑制剂减量和应用IVIG治疗是主要治疗措施。经治疗后,患者预后较好,但易复发。

Objective To investigate the diagnosis and treatment characteristics of pure red cell aplasia（ PRCA） caused by human parvovirus（ HPV） B19 infection after renal transplantation. Methods Two cases with PRCA caused by HPV B19-induced after renal transplantation,who were treated in the Department of Organ Transplantation,Nanfang Hospital,Southern Medical University,were summarized. Combined with literature review,the clinical characteristics,diagnostic method,course of treatment and prognosis of such disease were investigated. Results Two renal transplant recipients developed severe anemia early after transplantation with progressive deterioration and failed transfusion therapy. Other causes of anemia were ruled out and two patients were diagnosed as PRCA caused by HPV B19 infection according to bone marrow aspiration and biopsy as well as HPV DNA detection by fluorescent polymerase chain reaction（ PCR）. The symptoms of anemia were improved significantly after adjustment of immunosuppressive treatment protocol and intravenous immunoglobulin（ IVIG）. Conclusions For patients with unexplained and progressed anemia early after renal transplantation,especially those complicated with reticulocyte deficiency,the possibility of PRCA caused by HPV B19 infection shall be considered. The results of bone marrow aspiration and fluorescent PCR are the main bases for diagnosing PRCA. Immunosuppressive agents reduction and application of IVIG are the major treatment measures. Most of patients have great prognosis after treatment,but this disease is likely to recur.