Abstract:

Objective To investigate the clinical characteristics and treatment plans of anemia causedby human parvovirus B19V infection after kidney transplantation. Methods A total number of 5 patients with refractory anemia who underwent kidney transplantation surgery at the Organ Transplantation Center of the 924th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China were observed. Laboratorytests showed small cell hypochromic anemia，and after ruling out common causes of anemia，blood metagenomic next-generation sequencing（mNGS）testing showed positive for human parvovirus B19V. Treatment includederythropoietin，oral iron，intravenous injection of human immunoglobulin（400 mg/kg，d 1 ～ 5），adjusting theimmunosuppressive regimen（partially reducing the dose of tacrolimus，partially adjusting tacrolimus to cyclosporine） and other comprehensive treatments. Results After comprehensive treatment，4 cases among the 5 patients （80%）showed significant improvement in their conditions，1 case experienced recurrence，which was improved after intravenous injection of human immunoglobulin again. During treatment，1 case developed acute rejection reaction. Conclusion After kidney transplantation，patients with unexplained anemia and progressive exacerbationshould be alert to the possibility of human parvovirus B19V infection. Intravenous injection of human immunoglobulin is the preferred treatment method for pure red blood cell aplastic anemia caused by human parvovirus B19V infection after kidney transplantation. For recurrent patients，reapplication is still effective. Combined adjustment of immunosuppressive regimens and other comprehensive treatments can achieve ideal therapeutic effects. During thetreatment period，it is also necessary to closely monitor the functional status of the transplanted kidney to prevent rejection reactions. 

Key words:

"> Human parvovirus B19, Kidney transplantation, Pure red cell aplasia, Intravenousimmunoglobulin

摘要：

目的 探讨肾移植术后受者人微小病毒 B19（human parvovirus B19，B19V）感染所致贫血的临床特点及其治疗方案。 方法 以在中国人民解放军联勤保障部队第九二四医院器官移植中心接受同种异体肾移植手术的 5 例受者术后出现顽固性贫血为观察对象，实验室检查均为小细胞低色素性贫血，在排除常见贫血原因后，血液宏基因二代测序（metagenomic next-generation sequencing，mNGS）检测人微小病毒 B19V 阳性，给予患者促红素、口服铁剂、静脉注射人免疫球蛋白（400 mg/kg，第 1～5 天）、调整免疫抑制方案（他克莫司部分减量，部分调整他克莫司为环孢素）等综合治疗。 结果 在 5 例患者中，经综合治疗后，4 例（80%）患者病情得到明显缓解，1 例出现复发，经再次静脉注射人免疫球蛋白后好转，治疗期间 1 例合并急性排斥反应。 结论 肾移植术后对于出现不明原因贫血且进行性加重的患者，应警惕人微小病毒 B19V 感染的可能。规范疗程静脉注射人免疫球蛋白是肾移植术后人微小病毒 B19V 感染导致纯红细胞再生障碍性贫血的首选治疗方法，对于复发患者，再次应用仍然有效。联合调整免疫抑制剂方案等综合治疗，可获得理想疗效。同时在治疗期间还需密切监测移植肾功能状态，防止出现移植肾排斥反应。

关键词:

人微小病毒 B19V , 肾移植 , 纯红细胞再生障碍性贫血 , 静注人免疫球蛋白