Serjeant G R, Serjeant B E, Thomas P W, Anderson M J, Patou G, Pattison J R
British Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston.
Lancet. 1993 May 15;341(8855):1237-40. doi: 10.1016/0140-6736(93)91145-c.
We studied the epidemiology of human parvovirus B19 infection in 308 children with homozygous sickle cell (SS) disease and 239 controls with a normal haemoglobin (AA) genotype followed from birth in a cohort study. Annual serum samples identified the time and frequency of B19 infection, which did not differ between SS and AA children, about 40% of each group developing specific IgG by age 15. B19 infection followed an epidemic pattern similar to that observed for aplastic crises; accounted for all 91 aplastic crises that occurred; and was found in an additional 23 SS patients, of whom 10 showed mild haematological changes and 13 no changes. The magnitude or duration of IgG response did not differ between these groups. No patient had 2 attacks of aplasia and no patient nor control had 2 attacks of B19 infection. Following B19 infection, serial specific IgG concentrations remained high after 5 years in only 45% of SS patients, although the rarity of recurrent aplasia suggests lifelong immunity. B19 infection accounts for most if not all aplastic crises in SS disease, but at least 20% of infections do not result in aplasia. An effective vaccine against B19 might make an important contribution to the management of sickle cell disease.
在一项队列研究中，我们对308名患有纯合子镰状细胞（SS）病的儿童和239名血红蛋白基因型正常（AA）的对照儿童进行了人细小病毒B19感染的流行病学研究，这些儿童从出生起就被跟踪观察。每年采集血清样本以确定B19感染的时间和频率，SS组和AA组儿童之间并无差异，每组约40%的儿童在15岁时产生特异性IgG。B19感染呈现出与再生障碍危象相似的流行模式；所有91例发生的再生障碍危象均由其引起；在另外23名SS患者中也发现了B19感染，其中10名出现轻度血液学变化，13名无变化。这些组之间IgG反应的强度或持续时间没有差异。没有患者发生2次再生障碍发作，也没有患者或对照发生2次B19感染发作。B19感染后，仅45%的SS患者在5年后特异性IgG浓度仍保持高水平，尽管再生障碍复发罕见提示有终身免疫力。B19感染在SS病中即使不是所有再生障碍危象的病因，也是大多数再生障碍危象的病因，但至少20%的感染不会导致再生障碍。一种有效的B19疫苗可能对镰状细胞病的治疗做出重要贡献。
