Beare Nicholas A V, Harding Simon P, Taylor Terrie E, Lewallen Susan, Molyneux Malcolm E
St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom.
J Infect Dis. 2009 Jan 15;199(2):263-71. doi: 10.1086/595735.
In patients with cerebral malaria (CM), retinal angiography allows the study of infected central nervous system microvasculature in vivo. We aimed to examine retinal perfusion in children with CM by use of fluorescein angiography to investigate the pathophysiology of CM.
We performed fluorescein angiography on children with CM admitted to Queen Elizabeth Central Hospital, Malawi. We related angiograms to funduscopic findings.
Fluorescein angiography was performed for 34 patients with CM, and impaired perfusion was identified in 28 (82%). Areas of capillary nonperfusion (CNP) were seen in 26 patients (76%). Multiple, scattered areas of CNP were typical and topographically matched to retinal whitening. Larger retinal vessels were occluded in 9 patients (26%) who had associated ischemia. These vessels appeared white on ophthalmoscopy. Intravascular abnormalities were seen in 9 patients (26%), including filling defects and mottling of the blood column. Limited fluorescein leakage occurred in 15 patients (44%) and was not related to angiographic intravascular abnormalities or visible vessel discoloration.
Impaired perfusion occurs in the retinal microvasculature of most children with CM. This is evidence for hypoxia and ischemia as important components in the pathogenesis of CM. Vessel occlusion and filling defects are likely to be due to sequestration of infected erythrocytes. Interventions which improve perfusion or limit hypoxic injury may be beneficial in CM.
在脑型疟疾（CM）患者中，视网膜血管造影可在体内研究受感染的中枢神经系统微血管。我们旨在通过荧光素血管造影检查CM患儿的视网膜灌注情况，以研究CM的病理生理学。
我们对马拉维伊丽莎白女王中央医院收治的CM患儿进行了荧光素血管造影。我们将血管造影结果与眼底检查结果相关联。
对34例CM患者进行了荧光素血管造影，其中28例（82%）发现灌注受损。26例患者（76%）出现毛细血管无灌注（CNP）区域。多个散在的CNP区域较为典型，且在地形上与视网膜白化相匹配。9例（26%）伴有缺血的患者较大的视网膜血管闭塞。这些血管在检眼镜检查时呈白色。9例患者（26%）出现血管内异常，包括充盈缺损和血柱斑驳。15例患者（44%）出现有限的荧光素渗漏，且与血管造影血管内异常或可见血管变色无关。
大多数CM患儿的视网膜微血管存在灌注受损。这证明缺氧和缺血是CM发病机制中的重要组成部分。血管闭塞和充盈缺损可能是由于感染红细胞的扣押所致。改善灌注或限制缺氧损伤的干预措施可能对CM有益。
