Tangteerawatana Piyatida, Krudsood Srivicha, Kanchanakhan Naowarat, Troye-Blomberg Marita, Khusmith Srisin
Southeast Asian J Trop Med Public Health. 2014 May;45(3):517-30.
Immunity to malaria can be acquired but only after repeat exposures to polymorphic Plasmodium. However, the development of clinical outcomes during P. falciparum infection is not clearly understood. This study elucidated whether monocytes, neutrophils and pro/anti-inflammatory cytokines were associated with clinical outcomes in single infection and prior repeated malaria infections. Two hundred and seventy-nine patients with complicated and uncomplicated malaria were investigated. Peripheral blood IFN-gamma, TNF-alpha and IL-10 levels were measured by ELISA, and monocytes and neutrophils by an automated cell counter. On admission, in patients with uncomplicated malaria prior repeated infections, absolute neutrophil counts were positively and monocyte to neutrophil ratio negatively correlated significantly with parasitemia (r = 0.358, p = 0.000; r = -0.356, p = 0.000, respectively), while those with single infection absolute monocyte counts and monocyte to neutrophil ratio were significantly correlated negatively with IFN-gamma (r = -0.381, p = 0.001; r = -0.393, p = 0.000, respectively), and positively with TNF-alpha levels (r = 0.310, p = 0.007; r = 0.227, p = 0.017, respectively). In sharp contrast, in complicated malaria with single infection extremely high IFN-gamma and IL-10 levels but significantly low percent monocyte counts and monocyte to neutrophil ratio were seen. After 7 days of treatment, absolute monocyte counts and monocyte to neutrophil ratio were significantly increased, while absolute neutrophil counts significantly decreased (p = 0.000, 0.000, and 0.001, respectively), similarly after 28 days of treatment (p = 0.008, 0.000 and 0.000, respectively). These results suggest different functions of monocytes, neutrophils and pro/anti-inflammatory cytokines in complicated and uncomplicated malaria with single P. falciparum infection or prior repeated infections in the context of disease severity. Low monocyte to neutrophil ratio may be regarded as a risk factor in developing complication in primary malaria infection.
对疟疾的免疫力可以获得，但只有在反复接触多态性疟原虫之后。然而，恶性疟原虫感染期间临床结果的发展尚不清楚。本研究阐明了单核细胞、中性粒细胞以及促炎/抗炎细胞因子是否与单次感染及既往反复疟疾感染的临床结果相关。对279例复杂型和非复杂型疟疾患者进行了调查。采用酶联免疫吸附测定法检测外周血干扰素-γ、肿瘤坏死因子-α和白细胞介素-10水平，并用自动血细胞计数器检测单核细胞和中性粒细胞。入院时，在既往有反复感染的非复杂型疟疾患者中，绝对中性粒细胞计数与疟原虫血症呈显著正相关，单核细胞与中性粒细胞比值与疟原虫血症呈显著负相关（分别为r = 0.358，p = 0.000；r = -0.356，p = 0.000），而在单次感染患者中，绝对单核细胞计数和单核细胞与中性粒细胞比值与干扰素-γ呈显著负相关（分别为r = -0.381，p = 0.001；r = -0.393，p = 0.000），与肿瘤坏死因子-α水平呈正相关（分别为r = 0.310，p = 0.007；r = 0.227，p = 0.017）。形成鲜明对比的是，在单次感染的复杂型疟疾中，可见干扰素-γ和白细胞介素-10水平极高，但单核细胞计数百分比和单核细胞与中性粒细胞比值显著降低。治疗7天后，绝对单核细胞计数和单核细胞与中性粒细胞比值显著增加，而绝对中性粒细胞计数显著降低（分别为p = 0.000、0.000和0.001），治疗28天后情况类似（分别为p = 0.008、0.000和0.000）。这些结果表明，在恶性疟原虫单次感染或既往反复感染的复杂型和非复杂型疟疾中，单核细胞、中性粒细胞以及促炎/抗炎细胞因子在疾病严重程度方面发挥着不同的作用。单核细胞与中性粒细胞比值低可能被视为原发性疟疾感染发生并发症的一个危险因素。
