实体器官移植与弓形虫病

doi:10.12140/j.issn.1000-7423.2021.03.015

中国寄生虫学与寄生虫病杂志 ›› 2021, Vol. 39 ›› Issue (3): 386-392.doi: 10.12140/j.issn.1000-7423.2021.03.015

实体器官移植与弓形虫病

黄子芸¹(), 吕芳丽¹^,²^,³^,^*()

1 中山大学中山医学院寄生虫学教研室,广州 510080
2 中山大学热带病防治研究教育部重点实验室,广州 510080
3 广东省媒介生物防控工程技术研究中心,广州 510080

收稿日期:2020-09-21 修回日期:2020-11-19 出版日期:2021-06-30 发布日期:2021-07-05
通讯作者: 吕芳丽
作者简介:黄子芸（1993-）,女,博士研究生,从事寄生虫的感染和免疫机制研究。E-mail： 609797774@qq.com
基金资助:
国家自然科学基金面上项目(81971955);广东省自然科学基金面上项目(2019A1515011667);广东省自然科学基金面上项目(2021A1515012115);中山大学热带病防治研究教育部重点实验室开放基金(2020ZX02);2021年中山大学校级本科教学质量工程项目（中大教务[2021]93号）;2020年中山大学校级本科教学质量工程项目（中大教务[2020]72号）

Solid organ transplantation and toxoplasmosis

HUANG Zi-yun¹(), LV Fang-li¹^,²^,³^,^*()

1 Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
2 Key Laboratory of Tropical Disease of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, China
3 Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou 510080, China

Received:2020-09-21 Revised:2020-11-19 Online:2021-06-30 Published:2021-07-05
Contact: LV Fang-li
Supported by:
National Natural Science Foundation of China(81971955);Natural Science Foundation of Guangdong Province(2019A1515011667);Natural Science Foundation of Guangdong Province(2021A1515012115);Open Project of Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University(2020ZX02);Undergraduate Teaching Quality Engineering Project of Sun Yat-sen University（SYSU Undergraduate Education [2021]93）;Undergraduate Teaching Quality Engineering Project of Sun Yat-sen University（SYSU Undergraduate Education [2020]72）

摘要/Abstract

摘要：

免疫功能正常的人感染刚地弓形虫（简称弓形虫）后通常是无症状的,但免疫功能低下者感染可能出现严重的临床症状,甚至导致致命的后果。由于器官移植者实体移植器官的多样性、免疫抑制程度的差异性以及弓形虫病发病率相对较低等特点,临床上对器官移植受者弓形虫感染的风险认识不足。因此,本文就实体器官移植受者弓形虫病的临床表现、发病机制、诊断、预防和治疗作一综述,旨在为临床上实体器官移植后的弓形虫病诊治提供参考。

关键词: 弓形虫病, 实体器官移植, 发病机制, 诊断, 预防, 治疗

Abstract:

Toxoplasma gondii infection in immunocompetent people is often asymptomatic, but may lead to severe clinical symptoms in immunocompromised patients, even with fatal consequences. Due to the diversity of solid organ transplants, the degrees of immunosuppression, and the relatively low incidence of toxoplasmosis among organ transplant recipients, the clinical risk of T. gondii infection in organ transplant patients remains poorly understood. Therefore, this paper reviews the clinical manifestations, pathogenesis, diagnosis, prevention, and treatment of toxoplasmosis in solid organ transplant recipients, in order to provide reference for clinical diagnosis and treatment of toxoplasmosis after solid organ transplantation.

Key words: Toxoplasma gondii, Solid organ transplantation, Pathogenesis, Diagnosis, Prevention, Treatment

中图分类号:

R531.8

黄子芸, 吕芳丽. 实体器官移植与弓形虫病[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(3): 386-392.

HUANG Zi-yun, LV Fang-li. Solid organ transplantation and toxoplasmosis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(3): 386-392.

图/表 1

表1

1980—2020年不同实体器官移植后弓形虫病患者临床资料

病例信息	心脏移植（42例）	肝移植（20例）	肾移植（32例）
年龄/岁	3~64	7~62	14~74
性别	男（19例）,女（10例）,未知（13例）	男（5例）,女（12例）,未知（3例）	男（20例）,女（11例）,未知（1例）
D/R血清学	D⁺/R^-（27例）,D^-/R⁺（1例）, 未知/R^-（11例）,未知/R⁺（1例）, 未知（1例）	D⁺/R^-（7例）,D^-/R⁺（5例）, 未知/R^-（2例）,未知/R⁺（1例）, D⁺/R⁺（4例）,未知（1例）	D⁺/R^-（20例）,D^-/R⁺（2例）,未知/R^-（1例）,未知/R⁺（2例）,D^-/未知（1例）,D⁺/未知（1例）,未知（5例）
预防药物	无（30例）,PY + LKV（5例）,TMP + SMX（2例）,SF（1例）,ATO（1例）,PY + SDZ（1例）	无（10例）,TMP+SMX（4例）,PY + SDZ + LKV（1例）,未知（5例）	无（10例）,TMP + SMX（7例）,SF（2例）,未知（13例）
免疫抑制药物	P（25例）,AZ（16例）,CSA（15例）,ATG（14例）,MMF（6例）,TAC（4例）,MET（4例）	TAC（10例）,MMF（8例）,P（8例）,CSA（5例）,AZ（4例）,MET（4例）,ATG（2例）	CSA（18例）,ATG（14例）,P（12例）,MMF（11例）,AZ（8例）,MET（7例）,TAC（6例）,OKT3（3例）
移植后初始发病天数	5~30 d（15例）,31~90 d（10例）,91~365 d（8例）,2~12年（2例）,未知（7例）	2~30 d（11例）,31~90 d（3例）,91~365 d（3例）,未知（3例）	16 h~30 d（18例）,31~90 d（3例）,91~365 d（6例）,2~11年（5例）
临床症状	发热（19例）,脑炎（8例）,肺炎（8例）,呼吸窘迫（8例）,播散性弓形虫病（8例）,心肌炎（6例）,神经系统症状（6例）,脉络膜视网膜炎（3例）	发热（10例）,巨细胞病毒感染（8例）,肺炎（5例）,神经系统症状（3例）,脑水肿（2例）,败血症（2例）,白细胞减少（2例）	发热（10例）,巨细胞病毒感染（8例）,肺炎（5例）,神经系统症状（3例）,脑水肿（2例）,败血症（2例）,白细胞减少（2例）
发病机制	D⁺传染给R^-（29例）,隐性弓形虫感染活化（4例）,未知（9例）,	D⁺传染给R^-（9例）,隐性弓形虫感染的活化（10例）,未知（1例）	D⁺传染给R^-（20例）,隐性弓形虫感染活化（6例）,食用未煮熟肉类（2例）,未知（4例）,
感染后治疗药物	无（13例）,PY + SDZ（12例）,PY + SDZ + LKV（3例）,TMP + SMX（2例）,CLR + PY（2例）,PY（2例）,PY + SDZ + SF + CLR（1例）,PZA + SDZ + LKV（1例）,TMP + PY + SDZ + SP（1例）,ATO（1例）,未知（4例）	无（6例）,PY + SDZ（3例）,PY + SDZ + LKV（1例）,TMP + SMX（4例）,TMP + SMX + VA + MEM（1例）,CLR + TMP + SMX（1例）,SMX + AZM（1例）,VA+PRL + TZP（1例）,PY（1例）,CAZ + CIP + TEC + FCA（1例）	无（9例）,PY + SDZ（7例）,PY + SDZ + LKV（2例）,TMP + SMX（2例）,CLR + PY（3例）,CLR + TMP + SMX（1例）,SMX（1例）,PY + SDZ + ATO（1例）,VA + PY + CLR + LKV（1例）,CLR + PY + TMP + SMX（1例）,AZM（1例）,未知（3例）
预后	死亡（26例）,存活（16例）	死亡（10例）,存活（10例）	死亡（14例）,存活（17例）,未知（1例）
参考文献	13-17, 30, 32, 37, 39, 40, 44-49	3, 19, 22, 23, 29, 38, 41, 50-58	7, 24-28, 59-71

表1

参考文献 71

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实体器官移植与弓形虫病

Solid organ transplantation and toxoplasmosis

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