Gérardin Patrick, Rogier Christophe, Ka Amadou S, Jouvencel Philippe, Brousse Valentine, Imbert Patrick
Service de Pédiatrie, Hôpital Principal, Dakar, Senegal.
Am J Trop Med Hyg. 2002 Jun;66(6):686-91. doi: 10.4269/ajtmh.2002.66.686.
Thrombocytopenia is a common finding in malaria, but its prognostic value has not been addressed in children. The relationship between thrombocytopenia (platelet count < 100,000/mm3 on admission) and severity and outcome was investigated prospectively in children hospitalized with falciparum malaria in Dakar, Senegal, an area that is hypoendemic for malaria. Of 288 falciparum cases, 215 matched the 2000 World Health Organization definition of severe malaria. Median platelet counts were lower (98,000/mm3 versus 139,000/mm3; P < 0.02) among severe cases than in mild cases, and in children who died than among those who recovered (68,500/mm3 versus 109,000/mm3; P < 0.002). In severe cases, children presenting with a platelet count < 100,000/mm3 were more likely to die (odds ratio [OR] = 6.31, 95% confidence interval [CI] = 2.0-26.0). Moreover, multivariate analysis identified thrombocytopenia as an independent predictor of death (OR = 13.3, 95% CI = 3.2-55.1). Our data show an association between thrombocytopenia and either severity or prognosis in childhood falciparum malaria.
血小板减少症是疟疾中的常见表现，但在儿童中其预后价值尚未得到探讨。在疟疾低度流行地区塞内加尔达喀尔，对因恶性疟原虫疟疾住院的儿童，前瞻性地研究了血小板减少症（入院时血小板计数<100,000/mm³）与疾病严重程度及预后之间的关系。在288例恶性疟原虫病例中，215例符合2000年世界卫生组织严重疟疾的定义。严重病例的血小板计数中位数低于轻症病例（98,000/mm³对139,000/mm³；P<0.02），死亡儿童的血小板计数中位数低于康复儿童（68,500/mm³对109,000/mm³；P<0.002）。在严重病例中，血小板计数<100,000/mm³的儿童死亡可能性更大（比值比[OR]=6.31，95%置信区间[CI]=2.0 - 26.0）。此外，多变量分析确定血小板减少症是死亡的独立预测因素（OR = 13.3，95%CI = 3.2 - 55.1）。我们的数据表明，血小板减少症与儿童恶性疟原虫疟疾的严重程度或预后之间存在关联。
