肾移植术后人细小病毒B19感染的诊治体会

Report review and treatmentexperienceabout B19 virus infection afterkidney transplantation

目的探讨肾移植术后人细小病毒B19(human parvovirus B19,HPV-B19)感染导致单纯红细胞再生障碍性贫血(pure red cell aplasia,PRCA)的临床表现、检查、诊断和治疗方法。方法回顾性分析2016年5月~2019年2月我院收治的3例肾移植术后HPV-B19感染所致PRCA病人的临床诊治经过和转归。结果 3例病人均无特异性表现。确诊为HPV-B19感染后均接受对症治疗并1~2周的静脉输注免疫球蛋白(intravenous immunoglobulin,IVIG)。贫血均得到纠正。其中1例2个月后再次出现贫血并HPV-B19 DNA(+),给与调整免疫抑制剂并再次IVIG治疗,治疗效果明显。随访至今,病人移植肾功能无异常,未出现复发。结论肾移植术后HPV-B19感染所致PRCA主要表现为贫血相关症状,诊断依据血常规、骨髓细胞学检查和免疫学检查;治疗需调整免疫抑制剂,同时进行IVIG治疗,复发时同等强度治疗依然有效。

Objective To investigate the clinical features,auxiliary examination,diagnosis and treatment of pure red cell aplasia(PRCA) caused by human parvovirus B19(HPV-B19) infection after kidney transplantation,andto guide the treatment of diseases like this in future.Methods The clinical treatment and outcome of three patients with PRCA caused by HPV-B19 infection after kidney transplantation between May 2016 and February 2019 were retrospectively investigated.Results The three patients showed obvious anemia symptoms,lacking other clinical symptoms of viral infection.Two patients accept treatment of adjusting the dose of immunosuppressant;All three patients accept symptomatic treatment and 1 to 2 weeks of intravenous immunoglobulin after positive diagnosis,all of them showed clinical remission.One case occurred recrudescence with HPV-B19 DNA(+)and improved after the same treatment.All patients have blessing performance by now.No serious adverse reactions occurred and all patients had stable graft function.No accidents such as organ failure or immunological rejection showed at all.Conclusion The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms,blood examination,bone marrow cytology and immunological examination can diagnose HPV-B19 infection.Adjusting immunosuppressant and IVIG can be the safe and effective treatment.