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肝移植术后人类细小病毒B19感染的二代测序筛查及其相关危险因素分析

陈拓 李瑞东 应悦 陶一峰 沈丛欢 金嫣婷 王正昕

陈拓, 李瑞东, 应悦, 等. 肝移植术后人类细小病毒B19感染的二代测序筛查及其相关危险因素分析[J]. 器官移植, 2019, 10(6): 696-701. doi: 10.3969/j.issn.1674-7445.2019.06.011
引用本文: 陈拓, 李瑞东, 应悦, 等. 肝移植术后人类细小病毒B19感染的二代测序筛查及其相关危险因素分析[J]. 器官移植, 2019, 10(6): 696-701. doi: 10.3969/j.issn.1674-7445.2019.06.011
Chen Tuo, Li Ruidong, Ying Yue, et al. Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors[J]. ORGAN TRANSPLANTATION, 2019, 10(6): 696-701. doi: 10.3969/j.issn.1674-7445.2019.06.011
Citation: Chen Tuo, Li Ruidong, Ying Yue, et al. Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors[J]. ORGAN TRANSPLANTATION, 2019, 10(6): 696-701. doi: 10.3969/j.issn.1674-7445.2019.06.011

肝移植术后人类细小病毒B19感染的二代测序筛查及其相关危险因素分析

doi: 10.3969/j.issn.1674-7445.2019.06.011
基金项目: 

国家自然科学基金面上项目 81873874

国家自然科学基金面上项目 81773089

国家重大科技专项 2017ZX10203205

详细信息
    作者简介:

    陈拓,男,1994年生,硕士研究生,研究方向为肝胆肿瘤与肝移植的基础和临床研究,Email:zjwzct@163.com

    通讯作者:

    王正昕,男,1968年生,博士,主任医师,博士研究生导师,研究方向为肝胆肿瘤与肝移植的基础和临床研究,Email:wangzhengxin@huashan.org.cn

  • 中图分类号: R617, R619.3

Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors

More Information
  • 摘要:   目的  总结肝移植术后人类细小病毒(HPV)B19感染的筛查方法并分析相关危险因素。  方法  回顾性分析86例受者的临床资料。根据二代测序(NGS)  结果  分为HPV B19感染组和对照组, 分析HPV B19感染患者的临床特点、治疗方案及预后, 采用单因素和多因素Logistic回归向前LR逐步法分析HPV B19感染的危险因素。结果86例受者中9例受者肝移植术后2周左右出现不明原因发热伴进行性贫血, NGS检测提示HPV B19阳性, 诊断为HPV B19感染引起的纯红细胞再生障碍性贫血(PRCA)。所有患者给予静脉注射用免疫球蛋白(IVIG)治疗及免疫抑制方案调整后, 血红蛋白水平明显回升。多因素分析结果显示, 患者术后7 d外周血清球蛋白水平低[比值比(OR)=0.749, P=0.040]、年轻患者(OR=0.937, P=0.038)是肝移植术后HPV B19感染的独立危险因素。  结论  对于肝移植术后早期出现不明原因的血红蛋白水平下降的相对年轻患者, 需考虑HPV B19感染。NGS筛查是早期诊断HPV B19感染的有效方法。患者术后7 d外周血清球蛋白水平低和年龄(年轻患者)可能是其发生的独立危险因素。

     

  • 表  1  肝移植术后HPV B19感染患者一般情况

    Table  1.   General situation of patients with HPV B19 infection after liver transplantation

    例序 年龄(岁) 性别 合并感染情况 治疗前血常规 治疗后血常规
    Hb(g/L) WBC(×109/L) PLT(×109/L) Hb(g/L) WBC(×109/L) PLT(×109/L)
    1 39 HHV 5型 50 7 259 92 6 207
    2 46 86 3 100 116 5 108
    3 18 HHV 5型 64 2 81 116 5 150
    4 39 71 2 187 120 6 253
    5 38 HHV 6B型 85 3 212 110 9 224
    6 35 54 10 70 96 14 235
    7 51 HHV 5型 66 8 189 121 4 221
    8 47 78 2 46 112 5 111
    9 38 HHV 5型 77 9 113 12210 182
      –表示无; HHV为人类疱疹病毒; Hb为血红蛋白; WBC为白细胞; PLT为血小板
    下载: 导出CSV

    表  2  肝移植术后受者HPV B19感染的单因素分析

    Table  2.   Univariate analysis of HPV B19 infection in recipients after liver transplantation

    变量 感染组(n=9) 对照组(n=77) P
    性别[n(%)]
      男 7(78) 56(73) 1.000 a
      女 2(22) 21(27)
    年龄[M(R),岁] 39(10) 50(12) 0.003 c
    术前消化道出血情况[n(%)]
      有 1(11) 3(4) 0.363 b
      否 8(89) 74(96)
    术前胆红素水平[M(R),μ mol/L] 260(379) 31(123) 0.041 c
    术前血清肌酐水平[M(R),μ mol/L] 63(18) 64(24) 0.849 c
    术前PT-INR [M(R)] 2.1(1.4) 1.3(0.6) 0.034 c
    术前PT [M(R),s] 22(14) 15(8) 0.061 c
    术前淋巴细胞绝对值[M(R),×109/L] 1.3(0.5) 1.0(0.5) 0.076 c
    MELD评分[M(R),分] 25(21) 11(13) 0.043 c
    手术时间[n(%)]
      ≥ 7 h 2(22) 33(43) 0.404 a
       < 7 h 7(78) 44(57)
    术中出血量[n(%)]
       ≥ 1 L 7(78) 57(74) 1.000 a
      < 1 L 2(22) 20(26)
    术中输血量[n(%)]
      ≥ 1.5 L 6(67) 35(45) 0.394 a
       <1.5 L 3(33) 42(55)
    术后7 d外周血清球蛋白水平[M(R),g/L] 22(3) 23(5) 0.006 c
    住院时间[n(%)]
      ≥ 30 d 6(67) 34(44) 0.353 a
      < 30 d 3(33) 43(56)
    a使用连续校正的χ2检验; b使用Fisher确切概率法; c使用Mann-Whitney U秩和检验; PT为凝血酶原时间
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-08-10
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-11-15

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