肾移植术后微小病毒B19复发感染诊疗分析

Recurrent parvovirus in patients B19 infection after renal transplantation:a report of 8 cases

目的总结肾移植术后受者感染微小病毒B19(human parvovirus B19,HPV-B19)且多次复发的诊断方法、临床表现及防治措施。方法2020年6月至2022年5月于华中科技大学同济医学院附属同济医院器官移植中心行肾移植术后感染HPV-B19的37例受者中有8例复发,本研究对这8例受者的临床表现、诊疗措施、实验室检查及预后进行回顾性分析和总结。结果8例受者经过多疗程静脉注射丙种球蛋白(intravenous immunoglobulin G,IVIG)、转换免疫抑制剂及降低免疫抑制强度等综合治疗后,贫血症状改善,血红蛋白(hemoglobin,Hb)水平稳定,并在复发时使用同样治疗措施有效。8例受者最后1次复发后继续随访1年,8例受者再无复发且Hb水平稳定[(136.8±12.0)g/L],整个感染期间肾功能稳定。结论肾移植术后受者因免疫力低下,易感染HPV-B19且容易复发。当受者感染HPV-B19后,应定期监测Hb及网织红细胞水平,尤其是治疗好转的受者一旦再次出现Hb进行性下降应立即引起重视,进一步通过聚合酶链反应(polymerase chain reaction,PCR)法检测HPV-B19 DNA来判断是否复发。HPV-B19感染时应首选静脉注射IVIG来抗感染,当病情反复时,再次应用仍然有效且起到巩固治疗效果。结合调整免疫抑制剂方案及降低免疫抑制强度等综合治疗,可获得理想疗效。

Objective To summarize the diagnostic methods,clinical manifestations and prevention and treatment of recurrent human parvovirus B19(HPV-B19) infection in renal transplantation recipients.Methods From June 2020 to May 2022,8 out of 37 recipients infected with HPV-B19 after renal transplantation at Organ Transplantation Center of Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology were collected.The clinical manifestations,diagnosis and treatment measures,laboratory tests,and prognosis of these 8 patients were retrospectively analyzed and summarized.Results After multiple courses of intravenous immunoglobulin G(IVIG),conversion and reduction of immunosuppression and other comprehensive regimens,the anemia symptoms were improved and hemoglobin(Hb) level was stable in 8 patients.And the same treatment was effective when recurrent infections occur.Eight patients were followed up for one year after the last recurrence.There was no recurrence and the Hb level was stable [(136.8±12.0) g/L],and renal function was stable throughout the infection period.Conclusion Post-transplant recipients are susceptible to infection with HPV-B19 due to immunocompromise and are prone to reactive or recur many times.When patients are infected with HPV-B19,the levels of Hb and reticulocyte should be monitored regularly,especially in patients who have recovered from treatment.Once the progressive decline of Hb occurs again,attention should be paid immediately,and HPV-B19 DNA should be further tested by PCR to determine whether there is recurrence.Intravenous IVIG is the preferred treatment for HPV-B19 infection,and when the disease recurs,reapplication remains effective and reinforces the treatment effect.Combined with adjustment of immunosuppressive regimen,reduction of immunosuppression and other comprehensive regimens,the ideal curative effect can be achieved.