School of Medicine & Pharmacology, Fremantle Hospital & Health Service, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
Biomark Med. 2013 Jun;7(3):363-80. doi: 10.2217/bmm.13.50.
Malaria remains an important global cause of severe illness and mortality. This literature review summarizes available data on how biomarkers might be applied to diagnose, prognosticate and provide mechanistic insights in patients with severe malaria. Of the large number of candidate biomarkers, only PfHRP2 has consistently demonstrated clinical utility and, when incorporated into rapid antigen detection tests, has shown diagnostic sensitivity above 95%, which is at least as good as light microscopy. As a quantitative test, PfHRP2 also shows some promise in differentiating severe malarial from non-malarial disease in areas where asymptomatic carriage of malaria parasites is common, and possibly as a tool to estimate sequestered parasite burden and subsequent mortality. Biomarkers such as pLDH and panmalarial antigen have lower sensitivity for non-falciparum malaria in rapid antigen detection tests. There is an urgent need to discover and validate better biomarkers for incorporation into rapid antigen detection tests in countries where Plasmodium vivax is a common cause of severe disease. A large number of host-derived acute-phase reactants, markers of endothelial dysfunction and immune mediators have been proposed as biomarkers. Although they have provided mechanistic insights into the immunopathology of severe malaria, their roles as clinical tools remain uncertain.
疟疾仍然是全球严重疾病和死亡的重要原因。本文献综述总结了生物标志物在诊断、预后和提供严重疟疾患者机制见解方面的应用的现有数据。在大量候选生物标志物中，只有 PfHRP2 一直显示出临床实用性，并且当它被纳入快速抗原检测试验时，其诊断敏感性超过 95%，至少与显微镜检查一样好。作为一种定量检测，PfHRP2 在区分疟疾寄生虫无症状携带地区的严重疟疾和非疟疾疾病方面也显示出一些希望，并且可能作为一种工具来估计被隔离的寄生虫负担和随后的死亡率。在快速抗原检测试验中，pLDH 和全疟原虫抗原等生物标志物对非恶性疟原虫的敏感性较低。迫切需要发现和验证更好的生物标志物，以纳入到恶性疟原虫是严重疾病常见原因的国家的快速抗原检测试验中。大量宿主来源的急性期反应物、内皮功能障碍标志物和免疫介质已被提议作为生物标志物。尽管它们为严重疟疾的免疫病理学提供了机制见解，但它们作为临床工具的作用仍不确定。
