Kalanda Gertrude C, Hill Jenny, Verhoeff Francine H, Brabin Bernard J
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, and Royal Liverpool Children's Hospital NHS Trust, UK.
Trop Med Int Health. 2006 May;11(5):569-77. doi: 10.1111/j.1365-3156.2006.01608.x.
To compare the efficacy of chloroquine and sulphadoxine-pyremethamine against Plasmodium falciparum infection in pregnant women and in children from the same endemic areas of Africa, with the aim of determining the level of correspondence in efficacy determinations in these two risk groups.
Meta-analysis of nine published and unpublished in vivo antimalarial efficacy studies in pregnant women and in children across five African countries.
Pregnant women (all gravidae) were more likely to be sensitive than children to both chloroquine (odds ratio: 2.07; 95% confidence interval: 1.5, 2.9) and sulphadoxine-pyrimethamine (odds ratio: 2.66; 95% confidence interval: 11.1, 6.7). Pregnant women demonstrated an almost uniform increased sensitivity for peripheral parasite clearance at day 14 compared with children. This finding was consistent across a wide range of drug sensitivities. Primigravidae at day 14 showed lower clearance to antimalarial drugs than multigravidae (P<0.05). There was no significant difference between parasite clearance in primigravidae and in children.
The greater drug sensitivity in pregnant women probably indicates differences in host susceptibility rather than parasite resistance. Parasite sensitivity patterns in children may be a suitable guide to antimalarial policy in pregnant women.
比较氯喹和周效磺胺-乙胺嘧啶对非洲同一疟疾流行地区孕妇和儿童恶性疟原虫感染的疗效，以确定这两个风险群体疗效判定中的一致性水平。
对五个非洲国家已发表和未发表的九项关于孕妇和儿童体内抗疟疗效的研究进行荟萃分析。
孕妇（所有孕期）对氯喹（优势比：2.07；95%置信区间：1.5，2.9）和周效磺胺-乙胺嘧啶（优势比：2.66；95%置信区间：11.1，6.7）的敏感性均高于儿童。与儿童相比，孕妇在第14天外周血寄生虫清除率的敏感性几乎一致提高。这一发现在所研究的广泛药物敏感性范围内均一致。初产妇在第14天对抗疟药物的清除率低于经产妇（P<0.05）。初产妇和儿童的寄生虫清除率无显著差异。
孕妇较高的药物敏感性可能表明宿主易感性存在差异，而非寄生虫耐药性。儿童的寄生虫敏感性模式可能是孕妇抗疟政策的合适指导。
