Lell B, May J, Schmidt-Ott R J, Lehman L G, Luckner D, Greve B, Matousek P, Schmid D, Herbich K, Mockenhaupt F P, Meyer C G, Bienzle U, Kremsner P G
Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Germany.
Clin Infect Dis. 1999 Apr;28(4):794-9. doi: 10.1086/515193.
In regions highly endemic for Plasmodium falciparum malaria, red cell polymorphisms that confer resistance to severe disease are widespread. Sickle cell trait, alpha-thalassemia, glucose-6-phosphate dehydrogenase deficiency, and blood groups were determined in 100 children from Gabon with severe malaria who were matched with 100 children with mild malaria and followed up for evaluation of reinfections. The sickle cell trait was significantly associated with mild malaria and blood group A with severe malaria. During follow-up, the original severe cases had significantly higher rates of reinfection than the original mild cases, with higher parasitemia and lower hematocrit values. Incidence rates did not differ in the context of erythrocyte polymorphisms, but patients with sickle cell trait presented with markedly lower levels of parasitemia than those without. Thus, the severity of malaria is partly determined by the presence of blood group A and the sickle cell trait. The different presentation of reinfections in severe versus mild cases probably reflects different susceptibility to malaria.
在恶性疟原虫疟疾高度流行的地区，赋予对严重疾病抗性的红细胞多态性广泛存在。对来自加蓬的100名患有严重疟疾的儿童进行了镰状细胞性状、α地中海贫血、葡萄糖-6-磷酸脱氢酶缺乏症和血型检测，并与100名患有轻度疟疾的儿童进行匹配，随后对再感染情况进行评估。镰状细胞性状与轻度疟疾显著相关，而血型A与严重疟疾相关。在随访期间，最初的严重病例再感染率明显高于最初的轻度病例，其寄生虫血症更高，血细胞比容值更低。红细胞多态性情况下的发病率没有差异，但具有镰状细胞性状的患者寄生虫血症水平明显低于没有该性状的患者。因此，疟疾的严重程度部分由血型A和镰状细胞性状决定。严重病例与轻度病例再感染的不同表现可能反映了对疟疾的不同易感性。
