Sowunmi Akintunde, Balogun Sulayman T, Gbotosho Grace O, Happi Christian T
Department of Pharmacology & Therapeutics and Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
Acta Trop. 2009 Jan;109(1):55-60. doi: 10.1016/j.actatropica.2008.09.022. Epub 2008 Oct 17.
The effects of amodiaquine, artesunate and artesunate-amodiaquine on Plasmodium falciparum malaria-associated anaemia (PfMAA) and the recovery from PfMAA were evaluated in 328 children with uncomplicated malaria randomized to the standard dose regimens of the three drug treatments. Overall, malaria-attributable fall in haematocrit (MAFH) before treatment was 4.8+/-2.8%, 95% confidence interval (CI) 4.4-5.2%, and was not significantly different between the treatment groups (P=0.31). An age <5 years and a history of illness >3d were independent predictors of MAFH before treatment >4%. Following treatment, drug-attributable fall in haematocrit (DAFH) was significantly higher in amodiaquine-treated children (4.6+/-2.9%, 2.8+/-1.8%, 3.0+/-1.8% for amodiaquine, artesunate, artesunate-amodiaquine, respectively, P<0.0001). The rate of DAFH was significantly lower in artesunate-treated children (1.4+/-0.9%, 0.7+/-0.6%, 1.0+/-0.6% per day for amodiaquine, artesunate and artesunate-amodiaquine, respectively, P<0.0001). The rate of rise in haematocrit from the nadir on days 3-7 was significantly higher in amodiaquine treated children (P=0.045). In anaemic children (n=68), the time elapsing from treatment to the attainment of a haematocrit > or =30%, the anaemia resolution time, and the proportion of anaemic children with complete resolution on day 14 were similar in all treatment groups (P=0.17 and 0.65, respectively). Artemisinin drugs may reduce the extent and rate of fall in PfMAA during treatment and may attenuate malaria-associated anaemia in children.
在328名患单纯性疟疾的儿童中，评估了阿莫地喹、青蒿琥酯和青蒿琥酯-阿莫地喹对恶性疟原虫疟疾相关性贫血（PfMAA）的影响以及从PfMAA中恢复的情况，这些儿童被随机分配接受三种药物治疗的标准剂量方案。总体而言，治疗前疟疾导致的血细胞比容下降（MAFH）为4.8±2.8%，95%置信区间（CI）为4.4 - 5.2%，各治疗组之间无显著差异（P = 0.31）。年龄<5岁和患病史>3天是治疗前MAFH>4%的独立预测因素。治疗后，阿莫地喹治疗的儿童中药物导致的血细胞比容下降（DAFH）显著更高（阿莫地喹、青蒿琥酯、青蒿琥酯-阿莫地喹的DAFH分别为4.6±2.9%、2.8±1.8%、3.0±1.8%，P<0.0001）。青蒿琥酯治疗的儿童中DAFH速率显著更低（阿莫地喹、青蒿琥酯和青蒿琥酯-阿莫地喹每天的DAFH速率分别为1.4±0.9%、0.7±0.6%、1.0±0.6%，P<0.0001）。在第3 - 7天，阿莫地喹治疗的儿童血细胞比容从最低点上升的速率显著更高（P = 0.045）。在贫血儿童（n = 68）中，所有治疗组从治疗到血细胞比容达到≥30%的时间、贫血消退时间以及第14天完全消退的贫血儿童比例相似（分别为P = 0.17和0.65）。青蒿素类药物可能会降低治疗期间PfMAA下降的程度和速率，并可能减轻儿童疟疾相关性贫血。
