Abstract:

Objective To explore the therapeutic characteristics of human-parvovirus B19（HPV-B19）infection after renal transplantation. Methods Clinical data of patients infected with HPV-B19 after renal transplantation at the Organ transplant Center of Jiangxi Provincial People's Hospital from January 2018 to December2023 were retrospectively collected， and the patients were divided into Successful Group and Unsuccessful Group according to whether they had recurred after treatment. Important parameters，such as the difference of treatment regimen， hemoglobin count， hemoglobin count rise ratio， red blood cell count， red blood cell count rise ratio， serum creatinine rise ratio， serum creatinine rise ratio and the occurrence of rejection after treatment regimen change were compared. Results A total of 41 patients were included in the study， including 19 successful patients （SG） and 22 unsuccessful patients （USG）. Acute rejection （clinical diagnosis） occurred in 3 cases， of which 1 case in SG and 2 cases in USG. In the SG，16 cases were treated with dual immunosuppression regimen （13 cases were treated with cyclosporin A regimen and 3 cases were treated with tacrolimus regimen）. In the USG，7 patients received the dual immunosuppressiveregimen （4 patients received cyclosporine A and 3 patients received tacrolimus）. IVIG+RIS regimen was used in 13 patients in both the SG and the USG. There was a significant difference in hemoglobin on day 21 of treatment. On the 7thday of treatment， hemoglobin and red blood cell count increased significantly. There was no significant difference in serumcreatinine at 0，7，14 and 21 days of treatment. There was no significant difference in renal function regardless of whether the treatment was successful or not. After treatment， serum creatinine decreased to varying degrees without significantly increasing the incidence of rejection. Conclusion The dual immunosuppressive regimen combined with IVIG has the best therapeutic effect on HPV-B19 infection after renal transplantation， and does not significantly increase the incidence of rejection. Serum creatinine decreases to varying degrees after treatment， which also indicates that the treatment of HPV-B19 has a protective effect on renal function. Higher hemoglobin level on the 21st day of treatment， lower hemoglobin rise ratio and red blood cell count rise ratio on the 7th day of treatment are negatively correlated with the recurrence of infection， which have certain predictive value for the evaluation of infection recurrence. 

Key words:

Renal transplantation； , Human parvovirus B19； , Immunosuppression； , IVIG； , Therapeutics

摘要：

目的 探讨肾移植术后微小病毒 B19（human parvovirus B19，HPV-B19）感染的治疗特点。 方法 回顾性收集 2018 年 1 月至 2023 年 12 月江西省人民医院器官移植中心收治的肾移植术后 HPV-B19 感染患者的临床资料，根据治疗后是否复发将患者分为治愈组（successful group，SG）、复发组（unsuccessfulgroup，USG），对比治疗方案的不同、治疗不同观察点血红蛋白含量、血红蛋白含量上升比、红细胞计数、红细胞计数上升比、血清肌酐、血清肌酐上升比以及治疗方案改变后排斥反应的发生情况等重要参数。 结果 研究共纳入患者 41 例，其中 SG 19 例，USG 22 例，共发生排斥反应（临床诊断）3 例，其中 SG 1 例，USG 2 例；使用二联免疫抑制方案分别为 SG 16 例（16/19，84.2%）比 USG 7 例（7/22，31.8%），有显著差异；SG、USG 均有 13 例患者使用 IVIG + 减少免疫抑制强度（reduce immunosuppression， RIS）方案，其余患者均采取单纯减少免疫抑制强度治疗方案 ；治疗第 21 天血红蛋白、治疗第 7 天血红蛋白及红细胞计数上升比均有显著差异，治疗第 0、7、14、21 天血清肌酐没有显著差异 ；治愈成功与否对肾功能影响没有统计学差异，在治疗后肌酐均会出现不同程度的下降，不会显著增加排斥反应的发生率。 结论 二联免疫抑制方案联合 IVIG治疗效果最佳，不会显著增加排斥反应的发生率，在治疗后肌酐均会出现不同程度的下降，也提示微小病毒B19 的治疗对肾功能有保护作用。治疗第 21 天血红蛋白高、治疗第 7 天血红蛋白及红细胞计数上升比低对于感染的复发呈负相关，对于感染复发的评估有一定预测价值。 

关键词:

肾移植 ； 微小病毒 B19 ； 免疫抑制 ； 静脉注射用免疫球蛋白 ； 治疗 ,