Obonyo C O, Taylor W, Ekvall H, Kaneko A, Ter Kuile F, Olliaro P, Bjorkman A, Oloo A J
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578-40100, Kisumu, Kenya.
Ann Trop Med Parasitol. 2007 Jun;101(4):281-95. doi: 10.1179/136485907X176337.
Malaria-associated anaemia is a major public-health problem. Although the treatment of uncomplicated, Plasmodium falciparum malaria aims to clear the parasites, relieve the symptoms and permit haematological recovery, data on the impact of antimalarial treatment on haematological recovery are few. Haematological recovery and the prevalence of anaemia were therefore evaluated in 600 Kenyan children with uncomplicated malaria who were randomly assigned to one of three treatment groups. The children were given sulfadoxine-pyrimethamine (SP) on day 0, SP plus artesunate on day 0 (AS1), or SP on day 0 and artesunate on each of days 0-2 (AS3). Haemoglobin (Hb) concentrations were measured on days 0, 7, 14, 21 and 28, with haematological recovery defined as a day-28 Hb concentration of at least 11 g/dl. Only 96 (18%) of the 543 children who were anaemic (i.e. with <11.0 g Hb/dl) at enrolment achieved haematological recovery. The prevalence of anaemia fell from 91% on day 0 to 74% (252/340) by day 28 (P=0.065). Compared with SP alone, neither artesunate regimen resulted in higher Hb concentrations on day 28 (with means of 10.2, 9.9 and 10.2 g/dl for AS3, AS1 and SP, respectively; P=0.254), a higher frequency of haematological recovery (19%, 14% and 20% for AS3, AS1 and SP, respectively; P=0.301) or a greater reduction in the prevalence of anaemia (prevalences in the AS3, AS1 and SP arms falling from 90%, 89% and 93%, respectively, on day 0, to corresponding values of 71%, 82% and 69% on day 28; P=0.40). In fact, between days 0 and 7, the children in the AS3 arm showed a larger drop in mean Hb than the children in the other two treatment arms. In general, haematological recovery was most likely in older children who had mild anaemia at presentation and were parasitologically cured. Overall, the frequencies of haematological recovery were modest and not influenced by the artesunate treatments. Other factors contributing to anaemia need to be explored more fully.
疟疾相关性贫血是一个重大的公共卫生问题。尽管单纯性恶性疟原虫疟疾的治疗旨在清除寄生虫、缓解症状并促进血液学恢复，但关于抗疟治疗对血液学恢复影响的数据却很少。因此，对600名患有单纯性疟疾的肯尼亚儿童进行了血液学恢复情况及贫血患病率的评估，这些儿童被随机分配到三个治疗组之一。在第0天给儿童服用周效磺胺-乙胺嘧啶（SP），在第0天服用SP加青蒿琥酯（AS1），或在第0天服用SP并在第0 - 2天每天服用青蒿琥酯（AS3）。在第0、7、14、21和28天测量血红蛋白（Hb）浓度，血液学恢复定义为第28天Hb浓度至少为11 g/dl。在入组时贫血（即Hb < 11.0 g/dl）的543名儿童中，只有96名（18%）实现了血液学恢复。贫血患病率从第0天的91%降至第28天的74%（252/340）（P = 0.065）。与单独使用SP相比，两种青蒿琥酯治疗方案在第28天均未使Hb浓度更高（AS3、AS1和SP组的均值分别为10.2、9.9和10.2 g/dl；P = 0.254），血液学恢复频率也未更高（AS3、AS1和SP组分别为19%、14%和20%；P = 0.301），贫血患病率的降低幅度也未更大（AS3、AS1和SP组的患病率从第0天的90%、89%和93%分别降至第28天的71%、82%和69%；P = 0.40）。事实上，在第0至7天期间，AS3组儿童的平均Hb下降幅度大于其他两个治疗组的儿童。总体而言，年龄较大、就诊时为轻度贫血且寄生虫学治愈的儿童最有可能实现血液学恢复。总体而言，血液学恢复频率适中，且不受青蒿琥酯治疗的影响。导致贫血的其他因素需要更全面地加以探究。
