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

黄森林; 于立新; 邓文锋; 郭进明; 苗芸

doi:10.3969/j.issn.1674-7445.2015.04.009

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

doi: 10.3969/j.issn.1674-7445.2015.04.009

510050 广州，南方医科大学（黄森林，为临床医学八年制研究生）；南方医科大学南方医院器官移植科（于立新、邓文锋、郭进明、苗芸）

基金项目:

南方医科大学南方医院院长基金项目 2013B011

全国大学生创新创业训练计划项目 201412121029

详细信息

通讯作者:
苗芸, Email:miaoyunecho@126.com

中图分类号: R617
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出版历程
- 收稿日期: 2015-02-16
- 网络出版日期: 2021-01-19
- 刊出日期: 2015-07-15

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

Nanfang Medical University, 510050 Guangzhou, China

More Information

Corresponding author: Miao Yun, Email:miaoyunecho@126.com

摘要

摘要: 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。
- 肾移植 /
- 人类微小病毒B19 /
- 纯红细胞再生障碍性贫血 /
- 免疫球蛋白 /
- 复发
Abstract: 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.
- Renal transplantation /
- Human parvovirus B19 /
- Pure red cell aplasia /
- Immunoglobulin /
- Relapse

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图 1 微小病毒B19感染致纯红细胞再生障碍性贫血患者的骨髓穿刺涂片(吉姆萨染色，×1 000)

注：红细胞系比例减少, 可见巨大原始红细胞，原幼红细胞+早幼红细胞+中晚期红细胞 < 0.005，粒、巨核细胞系比例正常

Figure 1. Bone marrow aspiration smear of a patient with pure red cell aplasia caused by HPV B19 infection

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表 1 国内HPV B19感染致纯红细胞再生障碍性贫血再障的肾移植受者的病例特点

Table 1. Characteristics of pure red cell aplasia caused by human parvovirus B19 infection in Chinese renal transplant recipients

研究作者	n	基础免疫抑制方案	纯红再障发生距移植时间	最低血红蛋白水平(g/L)	诊断方法	治疗方案	复发情况
Xiao, et al^[2]	2	FK506+CsA+MMF	术后第9周	< 60	PCR检测HPV B19 DNA(+)	IVIG，停用MMF, FK506减半	1例复发，FK506改为CsA后治愈
李帅阳，等^[8]	4	FK506+MMF +泼尼松	术后第4周	56，74，48，42	HPV B19 IgM(+)	IVIG，停用MMF或Aza, FK506改为CsA，EPO	4例均复发，其中2例复发2次
Wong, et al^[9]	1	FK506+Aza+泼尼松	术后第4周	48	HPV B19 IgM(+)，PCR检测HPV B19 DNA (+)	IVIG，停用Aza, FK506改为CsA	多次复发，FK506改为CsA后治愈
Lui, et al^[10]	3	Csa+Aza+泼尼松	术后第4、4、12周	88，60，60	HPV B19 IgM(+)，PCR检测HPV B19 DNA(+)	1例自愈，2例使用IVIG	2例复发，其中1例出现严重并发症，于第4周死亡
黄森林，等(本文)	2	FK506+MMF+甲泼尼龙	术后第4、8周	63，39	PCR检测HPV B19 DNA(+)	FK506改为CsA，减量CsA，其中1例使用IVIG和EPO	1例复发
陈燕燕, 等^[11]	8	FK506+MMF+泼尼松	术后第4～13 d	50～73	PCR检测HPV B19 DNA(+)	IVIG, FK506改为CsA，停用MMF	1例复发
注：Aza为硫唑嘌呤(azathioprine); ATG为抗胸腺细胞球蛋白

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