Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - University of Barcelona), Barcelona, Spain; CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Manhiça Health Research Centre (CISM), Maputo, Mozambique.
Br J Haematol. 2014 Mar;164(6):877-87. doi: 10.1111/bjh.12716. Epub 2014 Jan 6.
There are no large-scale ex vivo studies addressing the contribution of Plasmodium falciparum in the bone marrow to anaemia. The presence of malaria parasites and haemozoin were studied in bone marrows from 290 anaemic children attending a rural hospital in Mozambique. Peripheral blood infections were determined by microscopy and polymerase chain reactions. Bone marrow parasitaemia, haemozoin and dyserythropoiesis were microscopically assessed. Forty-two percent (123/290) of children had parasites in the bone marrow and 49% (111/226) had haemozoin, overlapping with parasitaemia in 83% (92/111) of cases. Sexual and mature asexual parasites were highly prevalent (62% gametocytes, 71% trophozoites, 23% schizonts) suggesting their sequestration in this tissue. Sixteen percent (19/120) of children without peripheral infection had haemozoin in the bone marrow. Haemozoin in the bone marrow was independently associated with decreased Hb concentration (P = 0·005) and was more common in dyserythropoietic bone marrows (P = 0·010). The results of this ex vivo study suggest that haemozoin in the bone marrow has a role in the pathogenesis of malarial-anaemia through ineffective erythropoiesis. This finding may have clinical implications for the development of drugs targeted to prevent and treat malarial-anaemia.
目前尚无大规模的体外研究探讨恶性疟原虫在骨髓中对贫血的贡献。本研究在莫桑比克农村医院就诊的 290 名贫血儿童的骨髓中研究了疟原虫和疟色素的存在情况。通过显微镜检查和聚合酶链反应确定外周血液感染情况。通过显微镜评估骨髓中的寄生虫血症、疟色素和红细胞生成异常。290 名儿童中有 42%（123/290）的儿童骨髓中有寄生虫，49%（111/226）的儿童骨髓中有疟色素，其中 83%（92/111）的病例与寄生虫血症重叠。有性和成熟的无性寄生虫高度流行（62%配子体，71%滋养体，23%裂殖体），表明其在该组织中的隔离。16%（19/120）无外周感染的儿童骨髓中有疟色素。骨髓中的疟色素与 Hb 浓度降低独立相关（P=0.005），并且在红细胞生成异常的骨髓中更为常见（P=0.010）。这项体外研究的结果表明，骨髓中的疟色素通过无效的红细胞生成在疟原虫性贫血的发病机制中起作用。这一发现可能对开发预防和治疗疟原虫性贫血的靶向药物具有临床意义。
