摘要：人微小病毒 B19（human parvovirus B19，HPV-B19） 感染是实体器官移植术后常见的贫血原因，其临床表现以纯红细胞再生障碍性贫血为主，其他多不明显或无反应。HPV-B19的传播途径以呼吸道飞沫传播为主，其他包括输血传播、实体器官移植、母婴传播等。感染后产生特异性 IgM抗体，随后数天内产生保护性 IgG抗体以清除体内病毒。实体器官移植患者处于免疫抑制状态，无法完成有效的免疫应答，病毒持续复制。实体器官移植患者 HPV-B19 感染的诊断主要依靠 HPV-B19 DNA，若 HPV-B19 DNA 为阴性，临床仍不能排除HPV-B19感染，可行骨髓穿刺。HPV-B19感染的治疗无特异性抗病毒药物，主要依靠静脉应用免疫球蛋白、调整免疫抑制剂等。

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[1] ALBERT J EID, MONICA I Ardura. Human parvovirusB19 in solid organ transplantation: Guidelines from theAmerican society of transplantation infectious diseases community of practice [J]. Clinl Transplant, 2019,33(9):1-7.

[2] PATTISON JR, JONES SE, HODGSON J, et al. Parvovirus infections and hypoplastic crisis insickle- cell anaemia [J]. Lancet, 1981,1(822):664-665.

[3] QIU J, SÖDERLUND- VENERMO M, YOUNG NS.Human Parvoviruses [J]. Clin Microbiol Rev, 2017,30(1):43-113.

[4] JAIN A, KANT R. Genotypes of erythrovirus B19, theirgeographical distribution & circulation in cases with variousclinical manifestations [J]. Ind J Med Res, 2018,147(3):239-247.

[5] QIU YH, ZHAO ZH, QIU JM. Sequences of SevenComplete Genomes of Human Parvovirus B19 [J]. Microbiol Resour Announc, 2018,7(11):e00885-18.

[6] GANAIE SS, QIU J. Recent Advances in Replication andInfection of Human Parvovirus B19 [J]. Front Cell InfectMicrobiol, 2018,8:166.

[7] ANDERSON LJ, TSOU C, PARKER RA, et al. Detection of antibodies and antigens of human parvovirus B19by enzyme- linked immunosorbent assay [J]. J Clin Microbiol, 1986,24(4):522-526.

[8] 张欢,肖霞,李玉明,等.实体器官移植后细小病毒 B19感染导致单纯红细胞再生障碍性贫血 3例并文献复习[J].中华实验和临床病毒学杂志,2020,34(5):543-546.

[9] BELL LM, NAIDES SJ, STOFFMAN P, et al. Humanparvovirus B19 infection among hospital staff members after contact with infected patients [J]. N Engl J Med, 1989,321(8):485-491.

[10] GILLESPIE SM, CARTTER ML, ASCH S, et al. Occupational risk of human parvovirus B19 infection forschool and day- care personnel during an outbreak of erythema infectiosum [J]. JAMA, 1990,263(15):2061-2065.

[11] PORIGNAUX B, VUIBLET V, BARBE C, et al. Frequent occurrence of parvovirus B19 DNAemia in the firstyear after kidney transplantation [J]. J Med Virol, 2013,85(6):1115-1121.

[12] PARK JB, KIM DJ, WOO SY, et al. Clinical implications of quantitative real time- polymerase chain reaction ofparvovirus B19 in kidney transplant recipients- a prospective study. [J]. Transpl Int, 2010,22(4):455-462.

[13] 张晓伟,张雷,赵闻雨,等.肾移植术后微小病毒 B19感染 22例临床治疗经验[J].中华器官移植杂志,2019,40(6):323-327.

[14] THONGPRAYOON C, KHOURY N, BATHINI T, etal. Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta- analysis [J]. Urol Ann,2020,12(3):241-247.

[15] ANDERSON MJ, HIGGINS PG, DAVIS LR, et al. Experimental Parvoviral Infection in Humans [J]. J InfectDis, 1985,152(2):257-265.

[16] 杨帆,倪兆慧.肾移植患者细小病毒 B19感染的诊治进展[J].中华肾病研究电子杂志,2021,10(2):109-112.

[17] BARZON L, MURER L, PACENTI M, et al. Detectionof viral DNA in kidney graft preservation and washing solutions is predictive of posttransplant infections in pediatricrecipients [J]. J Infect Dis, 2009,200(9):1425-1433.

[18] 张陆阳,郭晔,竺晓凡.细小病毒 B19感染临床表现的多样性[J].国际输血及血液学杂志,2020,43(6):500-505.

[19] BRODIN- SARTORIUS A, MEKKI Y, BLOQUEL B,et al. Infection par le Parvovirus B19 après transplantationrénaleParvovirus B19 infection after kidney transplantation[J]. Néphrol Thér, 2012,8(1):5-12.

[20] EID AJ, BROWN RA, PATEL R, et al. ParvovirusB19 infection after transplantation: a review of 98 cases[J]. Clin Infect Dis, 2006,43(1):40-48.

[21] MENDE M, SOCKEL K. Parvovirus B19 Infection [J]. NEngl J Med, 2018,379(24):2361.

[22] PICHON M, LABOIS C, Tardy G, et al. Optimizednested PCR enhances biological diagnosis and phylogeneticanalysis of human parvovirus B19 infections [J]. Arch Virol, 2019,164(11):2775-2781.

[23] SIMPSON KE, STORCH GA, LEE CK, et al. HighFrequency of Detection by PCR of Viral Nucleic Acid inThe Blood of Infants Presenting with Clinical Myocarditis[J]. Pediatr Cardiol, 2016,37(2):399-404.

[24] EID AJ, CHEN SF. Human Parvovirus B19 in Solid Organ Transplantation [J]. Am J Transplant, 2013,13(s4):201-205.

[25] MOLENAAR- DE BACKER MW, RUSSCHER A, KROESAC, et al. Detection of parvovirus B19 DNA in blood: Viruses or DNA remnants [J]. J Clin Virol, 2016,84:19-23.

[26] 胡娜娜,许书添,董建华,等.肾移植术后人细小病毒 B19感染[J].肾脏病与透析肾移植杂志,2018,27(6):589-593.

[27] CRABOL Y, TERRIER B, ROZENBERG F, et al. Intravenous immunoglobulin therapy for pure red cell aplasiarelated to human parvovirus b19 infection: a retrospectivestudy of 10 patients and review of the literature [J]. ClinInfect Dis, 2013,56(7):968-977.

[28] GOSSET C, VIGLIETTI D, HUE K, et al. How manytimes can parvovirus B19- related anemia recur in solid organ transplant recipients [J]. Transpl Infect Dis, 2012,14(5):E64-E70.

[29] VO AA, CAM V, TOYODA M, et al. Safety and adverse events profiles of intravenous gammaglobulin products used for immunomodulation: a single-center experience[J]. Clin J Am Soc Nephrol, 2006,1(4):844-852.

[30] BAEK CH, KIM H, YANG WS, et al. Risk factors andlong- term outcomes of parvovirus B19 infection in kidneytransplant patients [J]. Transpl Infect Dis, 2017. doi: 10.1111/tid.12754.

[31] ROSADO- CANTO R, CARRILLO- PÉREZ DL, JIMÉNEZJV, et al. Treatment strategies and outcome of parvovirusB19 infection in kidney transplant recipients: a series andliterature review of 128 patients [J]. Rev Invest Clin, 2019,71(4):265-274.

[32] MANARESI E, GALLINELLA G. Advances in the Development of Antiviral Strategies Against Parvovirus B19[J]. Viruses, 2019,11(7):659.

[33] DAS P, CHATTERJEE K, CHATTOPADHYAY NR,et al. Evolutionary aspects of parvovirus B-19V associateddiseases and their pathogenesis patterns with an emphasison vaccine development [J]. Virus Disease, 2019,30(1):32-42.

[1]涂金鹏.实体器官移植术后人微小病毒B19感染研究进展[J].泌尿外科杂志(电子版),2021,13(02):15-18.

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人微小病毒B19（human parvovirus B19，HPVB19） 感染是实体器官移植术后常见的贫血原因。HPV-B19感染发生率较低，一定程度上限制了进一步临床研究。目前，各类实体器官移植术后均有HPV-B19感染的报道，但多以个案报道为主。由于长期服用免疫抑制剂，器官移植受者临床表现多不典型，持续的红细胞前体溶解可导致严重的纯红细胞再生障碍性贫血 （pure red cell aplasia，PRCA），并存在网织红细胞降低[1]。本文就实体器官移植术后HPV-B19感染的病原学、流行病学、临床表现、诊断策略、治疗方法及预防等方面进行综述。

1 病原学
2 流行病学
3 临床表现
4 诊断策略
5 治疗方法
6 预防

6 预防

在实体器官移植人群中，目前尚无明确有效的预防策略。美国移植学会推荐，感染者应进行飞沫隔离，并建议病房工作人员加强洗手[1]。一项研究显示，筛查供、受者 HPV-B19 以及肾组织中 HPVB19DNA，有助于预测移植后感染的风险，但这种诊断在移植受者中相对罕见，且成本偏高，不建议常规检查[17]。目前，没有数据支持实体器官移植患者应进行 IVIG 预防。有症状的 HPV-B19感染发生率偏低，IVIG 治疗成本偏高且存在肾毒性，不建议预防性应用[1]。重组 HPV-B19疫苗的开发可能有助于优化预防策略，目前仍需要进一步的研究[33]。

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