Nacher M, Treeprasertsuk S, Singhasivanon P, Silachamroon U, Vannaphan S, Gay F, Looareesuwan S, Wilairatana P
Unité INSERM 511, Immunobiologie Cellulaire et Moléculaire des Infections Parasitaires, Faculté de Médecine Pitié-Salpétrière, Paris, France.
Am J Trop Med Hyg. 2001 Dec;65(6):828-33. doi: 10.4269/ajtmh.2001.65.828.
We conducted a case record study comparing liver tests abnormalities in 20 malaria-related acute renal failure cases without cerebral malaria, 52 cerebral malaria cases without other organ impairment, 189 cases of nonsevere malaria associated with a high parasite burden, and 131 cases of mild Plasmodiumfalciparum malaria. Jaundice and hepatomegaly were significantly associated with renal failure (adjusted odds ratio [AOR], 3.3, 95% confidence interval [CI], 1.3-8.6, P = 0.01; and AOR, 1.7 95% CI, 1.13-2.4, P = 0.01) but not with cerebral malaria (AOR, 1, 95% CI, 0.5-2, P = 0.8; and AOR, 1.08, 95% CI, 0.8-1.8, P = 0.5). Patients with acute renal failure were significantly older and had increased liver abnormalities compared with other groups. Although an increase in the proportion of mature schizonts over ring forms was significantly associated with cerebral malaria, it did not seem to have affected acute renal failure. These results suggested that cytoadherence was not the main determinant for renal failure and that jaundice itself may have potentiated the effects of hypovolemia.
我们进行了一项病例记录研究，比较了20例无脑型疟疾的疟疾相关急性肾衰竭病例、52例无其他器官损害的脑型疟疾病例、189例伴有高寄生虫负荷的非重症疟疾病例和131例轻度恶性疟原虫疟疾病例的肝功能检查异常情况。黄疸和肝肿大与肾衰竭显著相关（校正比值比[AOR]为3.3，95%置信区间[CI]为1.3 - 8.6，P = 0.01；AOR为1.7，95% CI为1.13 - 2.4，P = 0.01），但与脑型疟疾无关（AOR为1，95% CI为0.5 - 2，P = 0.8；AOR为1.08，95% CI为0.8 - 1.8，P = 0.5）。与其他组相比，急性肾衰竭患者年龄显著更大且肝功能异常增加。尽管成熟裂殖体相对于环状体比例的增加与脑型疟疾显著相关，但似乎并未影响急性肾衰竭。这些结果表明，细胞黏附不是肾衰竭的主要决定因素，黄疸本身可能增强了血容量不足的影响。
