膦甲酸治疗肾移植受者中与人类细小病毒B19感染相关的纯红细胞再生障碍：一项初步探索。
Foscarnet Therapy for Pure Red Cell Aplasia Related to Human Parvovirus B19 Infection in Kidney Transplant Recipients: A Preliminary Exploration.
作者信息
Yu Yedong, Bao Ruijie, Lyu Junhao, Wu Jianyong, Chen Jianghua, Peng Wenhan
机构信息
Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.
出版信息
Infect Drug Resist. 2021 Jul 27;14:2911-2923. doi: 10.2147/IDR.S321936. eCollection 2021.
BACKGROUND
Parvovirus B19-associated pure red cell aplasia (PVB19-PRCA) is an uncommon but serious complication after kidney transplantation. Currently, intravenous immunoglobulin (IVIG) is preferred as the first-line treatment for PVB19-PRCA, but presents with disadvantages of disease recurrence and expensive cost. In this context, we propose that foscarnet therapy for kidney transplantation recipients (KTR) with PVB19-PRCA may be an alternative scenario. No related study has been reported, and we performed this study to assess the efficacy and safety of foscarnet for PVB19-associated PRCA in KTR.
METHODS
We conducted a retrospective review of PVB19-PRCA in KTR at our center over 9-year period. The data on therapy and outcomes in all cases treated with foscarnet are detailed records and summarized.
RESULTS
Among our 68 patients, PVB19-PRCA was confirmed in 50 based on inclusion/exclusion criteria. All patients presented with refractory anemia and low reticulocyte percentage (<0.5%), the mean hemoglobin of patients was 79.8±12.6g/L at the time of PVB19-PRCA was identified. The median serum genome copy number of parvovirus B19 at diagnosis was 9.6 log copies per milliliter. A total of 11 patients received foscarnet therapy, of 10 patients responded well to the treatment and maintained no recurrence. But 1 patient had a poor response to foscarnet therapy. Except for this patient, the mean hemoglobin level gradually increased from 68.5±9.3 g/L to 73.2±8.8 g/L, and the mean percentage of reticulocytes steadily increased from 0.1±0.0% to 7.6±2.9% after foscarnet therapy. The median serum genome copy number of parvovirus B19 decreased from 9.8 log to 6.1 log copies per milliliter. There was no significant difference (P=0.61, 0.60) in serum creatinine and glomerular filtration rate before and after foscarnet treatment. At the latest follow-up, the mean hemoglobin was 131.5±12.5 g/L and the hemoglobin correction occurred in all patients.
CONCLUSION
Foscarnet therapy doesn't seem to be worse than IVIG for PVB19-PRCA in KTR, and it can be an alternative option.
背景
细小病毒B19相关性纯红细胞再生障碍性贫血（PVB19-PRCA）是肾移植后一种罕见但严重的并发症。目前，静脉注射免疫球蛋白（IVIG）是PVB19-PRCA的一线首选治疗方法，但存在疾病复发和成本高昂的缺点。在此背景下，我们提出膦甲酸钠治疗肾移植受者（KTR）合并PVB19-PRCA可能是一种替代方案。尚无相关研究报道，我们开展本研究以评估膦甲酸钠治疗KTR中PVB19相关性PRCA的疗效和安全性。
方法
我们对本中心9年间KTR中PVB19-PRCA进行了回顾性研究。详细记录并总结了所有接受膦甲酸钠治疗病例的治疗及转归数据。
结果
在我们的68例患者中，根据纳入/排除标准确诊50例PVB19-PRCA。所有患者均表现为难治性贫血和网织红细胞百分比低（<0.5%），在确诊PVB19-PRCA时患者的平均血红蛋白为79.8±12.6g/L。诊断时细小病毒B19的血清基因组拷贝数中位数为每毫升9.6 log拷贝。共有11例患者接受了膦甲酸钠治疗，其中10例患者治疗反应良好且未复发。但有1例患者对膦甲酸钠治疗反应不佳。除该患者外，膦甲酸钠治疗后平均血红蛋白水平从68.5±9.3 g/L逐渐升至73.2±8.8 g/L，网织红细胞平均百分比从0.1±0.0%稳步升至7.6±2.9%。细小病毒B19的血清基因组拷贝数中位数从每毫升9.8 log降至6.1 log拷贝。膦甲酸钠治疗前后血清肌酐和肾小球滤过率无显著差异（P=0.61，0.60）。在最近一次随访时，平均血红蛋白为131.5±12.5 g/L，所有患者均出现血红蛋白纠正。
结论
对于KTR中PVB19-PRCA，膦甲酸钠治疗似乎并不比IVIG差，可作为一种替代选择。
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