Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland.
Clin Transl Med. 2013 Jan 7;2(1):1. doi: 10.1186/2001-1326-2-1.
Accurate stage determination is crucial in the choice of treatment for patients suffering from sleeping sickness, also known as human African trypanosomiasis (HAT). Current staging methods, based on the counting of white blood cells (WBC) and the detection of parasites in the cerebrospinal fluid (CSF) have limited accuracy. We hypothesized that immune mediators reliable for staging T. b. gambiense HAT could also be used to stratify T. b. rhodesiense patients, the less common form of HAT.A population comprising 85 T. b. rhodesiense patients, 14 stage 1 (S1) and 71 stage 2 (S2) enrolled in Malawi and Uganda, was investigated. The CSF levels of IgM, MMP-9, CXCL13, CXCL10, ICAM-1, VCAM-1, neopterin and B2MG were measured and their staging performances evaluated using receiver operating characteristic (ROC) analyses.IgM, MMP-9 and CXCL13 were the most accurate markers for stage determination (partial AUC 88%, 86% and 85%, respectively). The combination in panels of three molecules comprising CXCL13-CXCL10-MMP-9 or CXCL13-CXCL10-IgM significantly increased their staging ability to partial AUC 94% (p value < 0.01).The present study highlighted new potential markers for stage determination of T. b. rhodesiense patients. Further investigations are needed to better evaluate these molecules, alone or in panels, as alternatives to WBC to make reliable choice of treatment.
准确的分期对于选择治疗昏睡病（又称非洲人类锥虫病（HAT））患者至关重要。目前基于白细胞计数（WBC）和脑脊液（CSF）中寄生虫检测的分期方法准确性有限。我们假设可靠的免疫介质也可用于分期 T. b. gambiense HAT，还可用于分层 T. b. rhodesiense 患者，后者是 HAT 较少见的形式。
本研究纳入了 85 例 T. b. rhodesiense 患者，包括 14 例 1 期（S1）和 71 例 2 期（S2）患者，这些患者来自马拉维和乌干达。测量了 CSF 中的 IgM、MMP-9、CXCL13、CXCL10、ICAM-1、VCAM-1、新蝶呤和 B2MG 水平，并使用接收者操作特征（ROC）分析评估了它们的分期性能。
IgM、MMP-9 和 CXCL13 是最准确的分期标志物（部分 AUC 分别为 88%、86%和 85%）。由 CXCL13-CXCL10-MMP-9 或 CXCL13-CXCL10-IgM 组成的三种分子组合面板显著提高了其分期能力，部分 AUC 达到 94%（p 值 < 0.01）。
本研究强调了用于确定 T. b. rhodesiense 患者分期的新潜在标志物。需要进一步研究这些分子，单独或组合使用，作为白细胞计数的替代物，以可靠地选择治疗方案。
