Section Tropical Medicine, I, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Malar J. 2013 Jul 16;12:246. doi: 10.1186/1475-2875-12-246.
For rapid initiation of anti-malarial treatment and prevention of complications, early diagnosis and risk stratification is important in patients with Plasmodium falciparum malaria. Routine laboratory values do not correlate well with disease severity. The aim of this study was to determine the diagnostic and prognostic value of several biomarkers related to inflammation; endothelial and cardiac dysfunction; coagulation, and haemolysis in imported P. falciparum malaria.
In a prospective case-control study, 79 adult travellers with both uncomplicated and complicated P. falciparum malaria were included between 2007 and 2011. Forty-one healthy subjects were included as controls. Blood samples were obtained within 24 hours after first consultation to assess routine laboratory values as well as markers related to inflammation (PAPP-A, copeptin, CRP), endothelial activation (MPO, elastase-2, endothelin-1, sICAM-1, sVCAM-1), cardiac function (NT-proBNP, MR-proANP), coagulation (fibrinogen, D-dimers, platelet count), and haemolysis (LDH). Prognostic performance was assessed using the receiver operating characteristic curve (area under the curve = AUROC).
Twelve (15.2%) patients had severe P. falciparum malaria. In the patient group, significant thrombocytopaenia was found, all other markers but PAPP-A were significantly elevated. Diagnostic performance was best for CRP with an AUROC of 1.00, followed by MPO (0.99), D-dimers (0.98), elastase-2 (0.98), and sICAM-1 (0.98). Biomarker levels did not correlate well with disease severity.
The combination of travel history, fever prior to blood sampling, and CRP serum levels above or below 10.8 mg/l upon hospital admission, best discriminated between malaria patients and control persons. None of the biomarkers studied predicted the presence or the development of malaria complications, neither at the time of admission, nor during hospitalization.
为了快速启动抗疟治疗并预防并发症，对恶性疟原虫疟疾患者进行早期诊断和风险分层非常重要。常规实验室值与疾病严重程度相关性差。本研究旨在确定与炎症；内皮和心脏功能障碍；凝血和溶血相关的几种生物标志物在输入性恶性疟原虫疟疾中的诊断和预后价值。
在一项前瞻性病例对照研究中，纳入了 2007 年至 2011 年间 79 例成人旅行者的无并发症和并发症性恶性疟原虫疟疾患者。纳入 41 名健康受试者作为对照。在首次就诊后 24 小时内采集血样，以评估常规实验室值以及与炎症（PAPP-A、 copeptin、CRP）、内皮激活（MPO、弹性蛋白酶-2、内皮素-1、sICAM-1、sVCAM-1）、心脏功能（NT-proBNP、MR-proANP）、凝血（纤维蛋白原、D-二聚体、血小板计数）和溶血（LDH）相关的标志物。使用接收者操作特征曲线（曲线下面积=AUROC）评估预后性能。
12 例（15.2%）患者患有严重恶性疟原虫疟疾。在患者组中，发现显著血小板减少症，除 PAPP-A 外，所有其他标志物均显著升高。CRP 的诊断性能最佳，AUROC 为 1.00，其次是 MPO（0.99）、D-二聚体（0.98）、弹性蛋白酶-2（0.98）和 sICAM-1（0.98）。生物标志物水平与疾病严重程度相关性差。
在入院时，旅行史、发热、血清 CRP 水平高于或低于 10.8mg/l 与住院疟疾病人和对照者的最佳区分。在入院时或住院期间，研究中没有一种生物标志物可预测疟疾并发症的存在或发展。
