Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
J Infect Dis. 2010 Feb 15;201(4):570-9. doi: 10.1086/650301.
Parasite clearance data from 18,699 patients with falciparum malaria treated with an artemisinin derivative in areas of low (n=14,539), moderate (n=2077), and high (n=2083) levels of malaria transmission across the world were analyzed to determine the factors that affect clearance rates and identify a simple in vivo screening measure for artemisinin resistance. The main factor affecting parasite clearance time was parasite density on admission. Clearance rates were faster in high-transmission settings and with more effective partner drugs in artemisinin-based combination treatments (ACTs). The result of the malaria blood smear on day 3 (72 h) was a good predictor of subsequent treatment failure and provides a simple screening measure for artemisinin resistance. Artemisinin resistance is highly unlikely if the proportion of patients with parasite densities of <100,000 parasites/microL given the currently recommended 3-day ACT who have a positive smear result on day 3 is <3%; that is, for n patients the observed number with a positive smear result on day 3 does not exceed (n + 60)/24.
从全世界疟疾传播水平低（n=14539）、中（n=2077）和高（n=2083）地区采用青蒿素衍生物治疗的 18699 例恶性疟患者的寄生虫清除数据进行分析，以确定影响清除率的因素，并鉴定一种简单的青蒿素耐药性体内筛选方法。影响寄生虫清除时间的主要因素是入院时寄生虫密度。在高传播地区以及在基于青蒿素的联合治疗（ACT）中采用更有效的联合药物时，清除率更快。第 3 天（72 小时）疟疾病血涂片的结果是随后治疗失败的良好预测指标，并提供了一种简单的抗疟药耐药性筛选方法。如果在目前推荐的 3 天 ACT 治疗中，寄生虫密度<100,000 个/微升的患者中，第 3 天阳性血涂片结果的比例<3%（即 n 个患者中，第 3 天阳性血涂片结果的观察数不超过（n+60）/24），那么出现青蒿素耐药的可能性极小。
