Taylor T E, Molyneux M E, Wirima J J, Borgstein A, Goldring J D, Hommel M
Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Clin Exp Immunol. 1992 Dec;90(3):357-62. doi: 10.1111/j.1365-2249.1992.tb05851.x.
Hyperimmune globulin can inhibit and reverse the cytoadherence between Plasmodium falciparum-infected erythrocytes and melanoma cells in vitro. Cytoadherence is believed to mediate disease in cerebral malaria. Therefore we studied the efficacy of i.v. immunoglobulin, purified from the plasma of local semi-immune blood donors, as an adjunct to standard treatment for cerebral malaria in Malawian children. The immunoglobulin preparation (IFAT antimalarial antibody titre 1:5120) recognized erythrocyte-associated antigens of each of 22 Malawian P. falciparum isolates studied, and reversed binding of Malawian isolates to melanoma cells. Immunoglobulin did not reverse binding to human monocytes or to cells of the human histiocytic lymphoma cell line U937. Thirty-one children with P. falciparum parasitaemia and unrousable coma were enrolled. All were treated with i.v. quinine dihydrochloride; in addition patients were randomized to receive either immunoglobulin (400 mg/kg by i.v. infusion over 3 h) or placebo (albumen and sucrose by similar infusion) in a double blind trial with sequential analysis. Of 16 patients receiving immunoglobulin, five (31%) died and five survivors had neurological sequelae. Of 15 patients receiving placebo, one (7%) died and two had sequelae. Parasite clearance, fever clearance and coma resolution times in survivors were similar in the two groups. Although the difference in outcome between the two groups was not significant, the trial was stopped because immunoglobulin was demonstrated not to be superior to placebo.
高效价免疫球蛋白在体外可抑制并逆转恶性疟原虫感染的红细胞与黑色素瘤细胞之间的细胞黏附。细胞黏附被认为是脑型疟疾发病机制的介导因素。因此，我们研究了从当地半免疫献血者血浆中纯化的静脉注射免疫球蛋白作为马拉维儿童脑型疟疾标准治疗辅助药物的疗效。该免疫球蛋白制剂（间接荧光抗体试验抗疟抗体效价为1:5120）可识别所研究的22株马拉维恶性疟原虫分离株中每一株的红细胞相关抗原，并逆转马拉维分离株与黑色素瘤细胞的结合。免疫球蛋白不能逆转其与人类单核细胞或人组织细胞淋巴瘤细胞系U937细胞的结合。31例恶性疟原虫血症且昏迷无法唤醒的儿童入组。所有患儿均接受静脉注射二盐酸奎宁治疗；此外，在一项采用序贯分析的双盲试验中，患者被随机分配接受免疫球蛋白（400mg/kg，静脉输注3小时）或安慰剂（白蛋白和蔗糖，类似输注方式）。接受免疫球蛋白治疗的16例患者中，5例（31%）死亡，5例幸存者有神经后遗症。接受安慰剂治疗的15例患者中，1例（7%）死亡，2例有后遗症。两组幸存者的寄生虫清除、发热消退和昏迷缓解时间相似。尽管两组间的结局差异不显著，但由于证明免疫球蛋白并不优于安慰剂，该试验提前终止。
