Kwiatkowski D, Hill A V, Sambou I, Twumasi P, Castracane J, Manogue K R, Cerami A, Brewster D R, Greenwood B M
Institute of Molecular Medicine, Oxford University, UK.
Lancet. 1990 Nov 17;336(8725):1201-4. doi: 10.1016/0140-6736(90)92827-5.
Plasma levels of tumour necrosis factor (TNF) were significantly higher in 178 Gambian children with uncomplicated malaria due to Plasmodium falciparum than in 178 children with other illnesses. 110 children with cerebral malaria were studied shortly after admission to hospital; 28 subsequently died. Compared with the children with uncomplicated malaria, mean plasma TNF levels were twice as high in cerebral malaria survivors and ten times as high in the fatal cases. Although high TNF levels were associated with high parasitaemia and with hypoglycaemia, they predicted fatal outcome in cerebral malaria independently of parasitaemia and glucose concentrations. Concentrations of interleukin-1 alpha, but not interferon gamma, were also related to the severity of malaria. We conclude that increased TNF production is a normal host response to P falciparum infection, but that excessive levels of production may predispose to cerebral malaria and a fatal outcome.
178名因恶性疟原虫感染而患单纯性疟疾的冈比亚儿童的血浆肿瘤坏死因子（TNF）水平显著高于178名患有其他疾病的儿童。110名患脑型疟疾的儿童在入院后不久接受了研究；其中28名随后死亡。与患单纯性疟疾的儿童相比，脑型疟疾幸存者的平均血浆TNF水平是前者的两倍，而致命病例则是前者的十倍。虽然高TNF水平与高寄生虫血症和低血糖有关，但它们可独立于寄生虫血症和葡萄糖浓度而预测脑型疟疾的致命结局。白细胞介素-1α的浓度而非干扰素γ的浓度也与疟疾的严重程度有关。我们得出结论，TNF产生增加是宿主对恶性疟原虫感染的正常反应，但产生过量水平的TNF可能易引发脑型疟疾和致命结局。
