Holding P A, Stevenson J, Peshu N, Marsh K
KEMRI CRC Kilifi Unit, Kenya.
Trans R Soc Trop Med Hyg. 1999 Sep-Oct;93(5):529-34. doi: 10.1016/s0035-9203(99)90368-1.
Although cerebral malaria is the most common acute encephalopathy arising in children in Africa little is known of its effect upon the longer-term cognitive development of survivors. In Kenya, we compared the performance of 87 survivors of severe malaria with impaired consciousness to matched community controls on a wide range of tasks, not less than 42 months post illness episode. The presence of cognitive impairment was then related to both the pattern of symptoms at the time of the acute illness and the presence of gross neurological impairment on discharge. Significant group differences were found in areas of cognitive functioning suggestive of widespread impairment in the development of the ability to initiate, plan and carry out tasks (the executive functions). On tasks of more discrete cognitive skills (information processing) there were no significant group differences, although impaired performance was found more frequently in the severe malaria group. The odds ratio associated with the development of cognitive impairment following severe malaria with impaired consciousness was found to be 4.48 (95% CI 1.22, 16.47). A combination of 4 signs (coma, hypoglycaemia, seizures, and absence of hyperpyrexia) proved to have greater accuracy than the presence of gross neurological sequelae in predicting cognitive impairment (95% vs 93% specificity, 67% vs 58% sensitivity).
虽然脑型疟疾是非洲儿童中最常见的急性脑病，但其对幸存者长期认知发展的影响却鲜为人知。在肯尼亚，我们将87名意识受损的重症疟疾幸存者与相匹配的社区对照者在疾病发作后不少于42个月的时间里进行了一系列任务的表现比较。然后，认知障碍的存在与急性疾病发作时的症状模式以及出院时严重神经功能障碍的存在相关。在认知功能领域发现了显著的组间差异，提示启动、计划和执行任务的能力（执行功能）发展存在广泛受损。在更离散的认知技能（信息处理）任务上，虽然重症疟疾组中表现受损的情况更频繁出现，但没有显著的组间差异。意识受损的重症疟疾后发生认知障碍的比值比为4.48（95%可信区间1.22，16.47）。在预测认知障碍方面，4种体征（昏迷、低血糖、癫痫发作和无高热）的组合被证明比严重神经后遗症的存在具有更高的准确性（特异性95%对93%，敏感性67%对58%）。
