采用滤纸干血斑改良酶分析法在所罗门群岛伊莎贝尔省进行葡萄糖-6-磷酸脱氢酶缺乏症的人群筛查。

BACKGROUND

Glucose-6-phosphate dehydrogenase deficiency poses a significant impediment to primaquine use for the elimination of liver stage infection with Plasmodium vivax and for gametocyte clearance, because of the risk of life-threatening haemolytic anaemia that can occur in G6PD deficient patients. Although a range of methods for screening G6PD deficiency have been described, almost all require skilled personnel, expensive laboratory equipment, freshly collected blood, and are time consuming; factors that render them unsuitable for mass-screening purposes.

METHODS

A published WST8/1-methoxy PMS method was adapted to assay G6PD activity in a 96-well format using dried blood spots, and used it to undertake population screening within a malaria survey undertaken in Isabel Province, Solomon Islands. The assay results were compared to a biochemical test and a recently marketed rapid diagnostic test.

RESULTS

Comparative testing with biochemical and rapid diagnostic test indicated that results obtained by filter paper assay were accurate providing that blood spots were assayed within 5 days when stored at ambient temperature and 10 days when stored at 4 degrees. Screening of 8541 people from 41 villages in Isabel Province, Solomon Islands revealed the prevalence of G6PD deficiency as defined by enzyme activity < 30% of normal control was 20.3% and a prevalence of severe deficiency that would predispose to primaquine-induced hemolysis (WHO Class I-II) of 6.9%.

CONCLUSIONS

The assay enabled simple and quick semi-quantitative population screening in a malaria-endemic region. The study indicated a high prevalence of G6PD deficiency in Isabel Province and highlights the critical need to consider G6PD deficiency in the context of P. vivax malaria elimination strategies in Solomon Islands, particularly in light of the potential role of primaquine mass drug administration.

背景

葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症可导致严重溶血性贫血，对使用伯氨喹消除间日疟原虫肝期感染和清除配子体造成严重阻碍。尽管已有多种 G6PD 缺乏症的筛查方法，但几乎都需要专业人员、昂贵的实验室设备、新鲜采集的血液，且耗时较长，因此不适合大规模筛查。

方法

对已发表的 WST8/1-甲氧基 PMS 法进行改良，使其适用于 96 孔板干血斑法检测 G6PD 活性，并在在所罗门群岛伊萨贝尔省开展的疟疾调查中进行人群筛查。将检测结果与生化检测和市场上推出的快速诊断检测方法进行比较。

结果

与生化和快速诊断检测相比，当干血斑在室温下储存 5 天或在 4°C 下储存 10 天时，滤纸片检测结果准确。对伊萨贝尔省 41 个村庄的 8541 人进行筛查发现，按酶活性<正常对照的 30%定义的 G6PD 缺乏症患病率为 20.3%，有导致伯氨喹诱导溶血（世界卫生组织 I 类-Ⅱ类）风险的严重缺乏症患病率为 6.9%。