镰状细胞性状和镰状细胞杂合子对无并发症恶性疟、贫血和儿童生长的不同影响。
Differing effects of HbS and HbC traits on uncomplicated falciparum malaria, anemia, and child growth.
机构信息
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
出版信息
Blood. 2010 Jun 3;115(22):4551-8. doi: 10.1182/blood-2009-09-241844. Epub 2010 Mar 15.
The high prevalence of hemoglobin S (HbS) in Africa and hemoglobin C (HbC) in parts of West Africa is caused by the strong protection against severe falciparum malaria during childhood. Much less is known about the effect of HbS and especially HbC on Plasmodium falciparum infection, uncomplicated malaria, and anemia. A total of 1070 children from the Ashanti Region, Ghana, were enrolled at the age of 3 months and visited monthly until 2 years of age. The effects of the beta-globin genotype on the age-dependent incidence of malaria, levels of parasitemia, and hemoglobin as well as physical development were analyzed by population-averaged models. Infants with HbAS were protected from uncomplicated malaria (P < .005) and anemia (P < .001), had lower age-adjusted parasite densities (P < .001), and higher age-adjusted hemoglobin levels compared with children with the HbAA genotype (P = .004). In contrast, HbAC carriers had lower hemoglobin levels (P < .033) and were not protected against malaria or anemia. Notably, infants with HbAS were also significantly protected against stunting compared with carriers of HbAA or HbAC. This indicates differing mechanisms of protection against malaria of HbAS and HbAC and might help to understand why HbC is restricted to distinct areas of West Africa.
在非洲,血红蛋白 S(HbS)的高发率和西非部分地区血红蛋白 C(HbC)的高发率是由儿童期对严重恶性疟原虫感染的强烈保护作用引起的。然而,人们对 HbS 尤其是 HbC 对恶性疟原虫感染、无并发症疟疾和贫血的影响知之甚少。加纳阿散蒂地区共有 1070 名儿童在 3 个月大时入组,并在 2 岁前每月进行一次随访。通过人群平均模型分析了β珠蛋白基因型对疟疾发病率、寄生虫血症水平和血红蛋白以及身体发育的年龄依赖性影响。与 HbAA 基因型的儿童相比,HbAS 基因型的婴儿对无并发症疟疾(P <.005)和贫血(P <.001)有保护作用,年龄调整后的寄生虫密度较低(P <.001),年龄调整后的血红蛋白水平较高(P =.004)。相比之下,HbAC 携带者的血红蛋白水平较低(P <.033),并且不能预防疟疾或贫血。值得注意的是,与携带 HbAA 或 HbAC 的婴儿相比,HbAS 携带者的婴儿也明显受到保护,不易出现发育迟缓。这表明 HbAS 和 HbAC 对疟疾的保护作用机制不同,这可能有助于理解为什么 HbC 只局限于西非的特定地区。