Krishna S, Taylor A M, Supanaranond W, Pukrittayakamee S, ter Kuile F, Tawfiq K M, Holloway P A, White N J
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Lancet. 1999 Feb 13;353(9152):546-9. doi: 10.1016/s0140-6736(98)06316-8.
Thiamine deficiency (beriberi) is common in some parts of southeast Asia. Acute thiamine deficiency can mimic many complications of malaria, such as encephalopathy and lactic acidosis. We examined the incidence of thiamine deficiency in adults admitted to hospital with malaria in Thailand.
For this prospective study, we recruited consecutive patients with malaria or other febrile illness who presented to Paholpolpayuhasena Hospital, Kanchanaburi, Thailand, between May and July, 1992. We used the activation coefficient (alpha) for transketolase activity in erythrocytes to measure thiamine deficiency (defined as alpha>1.31) in patients with severe and uncomplicated malaria and in controls (patients' relatives and healthy volunteers). To exclude the possibility of interference in the assays, transketolase activity was also measured in erythrocytes used to culture parasites.
12 (52%) of 23 patients with severe malaria and ten (19%) of 54 patients with uncomplicated malaria had alpha values above the normal range (p<0.0001 and p=0.0014, respectively, compared with controls), which indicated severe thiamine deficiency. Thiamine deficiency was more severe in patients with cerebral malaria than in those with uncomplicated malaria and the controls (p=0.008).
In adults admitted to hospital in Thailand, thiamine deficiency commonly complicates acute falciparum malaria, particularly in severe infections, and could contribute to dysfunction of the central nervous system.
硫胺素缺乏（脚气病）在东南亚某些地区很常见。急性硫胺素缺乏可类似疟疾的许多并发症，如脑病和乳酸性酸中毒。我们调查了泰国因疟疾住院的成年人中硫胺素缺乏的发生率。
在这项前瞻性研究中，我们招募了1992年5月至7月期间到泰国北碧府帕霍波尔帕尤哈塞纳医院就诊的连续的疟疾患者或其他发热性疾病患者。我们使用红细胞中转酮醇酶活性的激活系数（α）来测量重症和非重症疟疾患者以及对照组（患者亲属和健康志愿者）中的硫胺素缺乏情况（定义为α>1.31）。为排除检测干扰的可能性，还在用于培养寄生虫的红细胞中测量了转酮醇酶活性。
23例重症疟疾患者中有12例（52%），54例非重症疟疾患者中有10例（19%）的α值高于正常范围（与对照组相比，p分别<0.0001和p = 0.0014），这表明存在严重的硫胺素缺乏。脑型疟疾患者的硫胺素缺乏比非重症疟疾患者和对照组更严重（p = 0.008）。
在泰国住院的成年人中，硫胺素缺乏常使急性恶性疟疾复杂化，尤其是在严重感染时，并且可能导致中枢神经系统功能障碍。
