肾移植受者人类微小病毒B19感染临床诊疗技术规范（2022版）

中华医学会器官移植学分会; 国家肾脏移植质控中心

doi:10.3969/j.issn.1674-7445.2022.02.001

肾移植受者人类微小病毒B19感染临床诊疗技术规范（2022版）

doi: 10.3969/j.issn.1674-7445.2022.02.001

100039 北京，中国人民解放军总医院第三医学中心（金海龙、张庆）；西安交通大学第一附属医院（丁晨光）

基金项目:

国家自然科学基金面上项目 82070768

详细信息

中图分类号: R617, R373
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- 被引次数: 0
出版历程
- 收稿日期: 2022-01-02
- 网络出版日期: 2022-03-18
- 刊出日期: 2022-03-15

Technical specification for clinical diagnosis and treatment of human parvovirus B19 infection in kidney transplant recipients (2022 edition)

The 3th Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China

摘要

摘要: 肾移植受者长期使用免疫抑制剂，导致其免疫功能低下，容易伴发各种病原体感染。近年来随着人类微小病毒B19（HPV-B19）感染的检测技术发展和肾移植手术的增多，肾移植术后HPV-B19的感染率呈逐年上升的趋势，是导致术后纯红细胞再生障碍性贫血（PRCA）的重要原因之一，影响移植肾功能恢复，甚至导致移植肾损伤或预后不良。为了进一步规范肾移植受者HPV-B19感染的诊断和治疗，中华医学会器官移植学分会和国家肾脏移植质控中心组织专家，从HPV-B19病原学、流行病学特点、临床表现、诊断、预防、治疗、存在的问题及展望等方面，制订肾移植术后HPV-B19感染的临床诊疗规范，以期为我国肾移植术后HPV-B19感染的规范化防治提供指导。
- 人类微小病毒B19（HPV-B19） /
- 纯红细胞再生障碍性贫血（PRCA） /
- 促红细胞生成素（EPO） /
- 信号转导和转录激活因子（STAT） /
- 抗人T细胞免疫球蛋白（ALG） /
- 静脉注射用人免疫球蛋白（IVIG） /
- 二代测序（NGS） /
- 西多福韦 /
- 羟基脲 /
- 膦甲酸钠
Abstract: Long-term use of immunosuppressant in kidney transplant recipients leads to poor immune function and infection with various pathogens. In recent years, along with the advancement of detection technique of human parvovirus B19 (HPV-B19) infection and the increasing quantity of kidney transplantation, the infection rate of HPV-B19 after kidney transplantation has been elevated year by year, becoming one of the major causes of pure red cell aplasia (PRCA), affecting the recovery of renal allograft function, and even leading to the injury or poor prognosis of renal allograft. To further standardize the diagnosis and treatment of HPV-B19 infection in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association and National Kidney Transplantation Quality Control Center jointly organized experts to formulate the clinical diagnosis and treatment specification for HPV-B19 infection after kidney transplantation from the perspectives of etiology, epidemiological characteristics, clinical manifestations, diagnosis, prevention, treatment, existing problems and prospects of HPV-B19, aiming to provide guidance for standardized prevention and treatment of HPV-B19 infection post-kidney transplantation in China.
- Human parvovirus B19 (HPV-B19) /
- Pure red cell aplasia (PRCA) /
- Erythropoietin (EPO) /
- Signal transducer and activator of transcription (STAT) /
- Anti-human T lymphocyte immunoglobulin (ALG) /
- Intravenous immunoglobulin (IVIG) /
- Next generation sequencing (NGS) /
- Cidofovir /
- Hydroxyurea /
- Foscarnet sodium
注释:

1) 作者简介：金海龙，男，1972年生，医学博士，副主任医师，研究方向为肾脏移植、移植免疫、器官捐献，Email：jhl309@sina.com

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表 1 肾移植受者HPV-B19感染的主要危险因素

Table 1. Main risk factors of HPV-B19 infection in kidney transplant recipients

分类	危险因素
供者因素	HPV-B19血清学或HPV-B19 DNA阳性
供者因素	尸体供肾移植或心脏死亡器官捐献供肾移植
	术前隐性HPV-B19感染
	HLA ^①高度不匹配（≥ 4个不匹配）
	儿童
受者因素	他克莫司血药浓度较高（> 8 ng/mL）
	ALG多克隆抗体诱导治疗
	输血或血液制品（凝血因子Ⅷ、凝血酶原复合物、纤维蛋白原、冷沉淀等）
	贫血或发病前3个月内血红蛋白下降水平
	全血细胞减少
注：① HLA为人类白细胞抗原。

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表 2 HPV-B19感染相关的几种疾病

Table 2. Several diseases related to HPV-B19 infection

疾病类别	常见发病人群
慢性PRCA	免疫抑制患者
器官侵袭性疾病	免疫抑制患者
关节病	免疫力正常成人
感染性红斑	免疫力正常儿童
心肌炎	免疫力正常儿童
胎儿水肿或胎儿死亡	胎儿或妊娠期女性
短暂再生障碍性贫血危象	溶血性贫血患者
特发性血小板减少性紫癜	免疫力正常儿童
血管性紫癜	儿童或成人
血管炎	儿童或成人

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表 3 肾移植受者HPV-B19感染的临床诊断

Table 3. Clinical diagnosis of HPV-B19 infection in kidney transplant recipients

分类	诊断依据
怀疑HPV-B19感染的临床表现：符合表中（1）+（2）+（3），和（或）（4）	（1）贫血：持续性或严重贫血（Hb < 60 g/L），且伴RET减少症和对EPO缺乏反应；可伴或不伴发热、关节痛、皮疹、白细胞减少及血小板减少等
	（2）排除药物因素或其他原因导致的贫血，如骨髓抑制、失血、肿瘤或营养缺乏等因素
	（3）实验室检查：Hb呈进行性下降，红细胞明显减少，RET显著减少（RET% < 0.5%），部分患者可伴有全血细胞减少
	（4）器官侵袭性疾病：如肾小球疾病、肝炎、心肌炎、肺炎、血管炎及神经系统疾病等，且排除其他导致这些疾病的因素
疑似HPV-B19感染的初步检查	（1）HPV-B19的血清学（IgG和IgM）：HPV-B19 IgM阳性
	（2）血清或全血qRT-PCR：HPV-B19 DNA阳性
	（3）NGS技术：检出高序列数的HPV-B19
当强烈怀疑HPV-B19感染，血清学和PCR呈阴性时	（1）进行骨髓穿刺活检及原位杂交或免疫组织化学染色
当强烈怀疑HPV-B19感染，血清学和PCR呈阴性时	（2）骨髓表现：符合HPV-B19相关PRCA的特点

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