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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. 肾移植受者人类微小病毒B19感染临床诊疗技术规范(2022版)[J]. 器官移植, 2022, 13(2): 135-143. doi: 10.3969/j.issn.1674-7445.2022.02.001
引用本文: 中华医学会器官移植学分会, 国家肾脏移植质控中心. 肾移植受者人类微小病毒B19感染临床诊疗技术规范(2022版)[J]. 器官移植, 2022, 13(2): 135-143. doi: 10.3969/j.issn.1674-7445.2022.02.001
Branch of Organ Transplantation of Chinese Medical Association, National Kidney Transplantation Quality Control Center. Technical specification for clinical diagnosis and treatment of human parvovirus B19 infection in kidney transplant recipients (2022 edition)[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 135-143. doi: 10.3969/j.issn.1674-7445.2022.02.001
Citation: Branch of Organ Transplantation of Chinese Medical Association, National Kidney Transplantation Quality Control Center. Technical specification for clinical diagnosis and treatment of human parvovirus B19 infection in kidney transplant recipients (2022 edition)[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 135-143. 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
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

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

  • 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。

     

  • 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
    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 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。
    下载: 导出CSV

    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
    下载: 导出CSV

    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
    (2)骨髓表现:符合HPV-B19相关PRCA的特点
    下载: 导出CSV
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  • 收稿日期:  2022-01-02
  • 网络出版日期:  2022-03-18
  • 刊出日期:  2022-03-15

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