妊娠期间恶性疟原虫负担、免疫力和疾病的变化趋势。

Changing Trends in P. falciparum Burden, Immunity, and Disease in Pregnancy.

机构信息

From the Barcelona Institute for Global Health (ISGlobal), Barcelona Center for International Health Research (CRESIB), and Hospital Clínic-Universitat de Barcelona (A.M., A.B., A.M.F., R.G., P.C., M.R., J.C., A.J., L.F., J.J.A., C.D., P.L.A., C.M.), Barcelona, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEREsp), Madrid (A.J.) - all in Spain; Centro de Investigação em Saúde da Manhiça (CISM) (A.M., A.B., E.M., T.N., R.G., S. Maculuve, M.R., A.V., B.S., S. Machevo, A. Nhama, L.L., J.J.A., S.A., A. Nhacolo, C.D., E.S., P.L.A., C.M.), Instituto Nacional de Saúde, Ministry of Health (T.N., S. Maculuve, B.S., A. Nhama, S.A.), and Faculdade de Medicina, Universidade Eduardo Mondlane (S. Machevo, E.S.) - all in Maputo, Mozambique; the Graduate Program in Areas of Basic and Applied Biology, Universidade do Porto, Porto, Portugal (A.M.F.); and the International Center for Genetic Engineering and Biotechnology, New Delhi, India (C.C.).

出版信息

N Engl J Med. 2015 Oct 22;373(17):1607-17. doi: 10.1056/NEJMoa1406459.

DOI:10.1056/NEJMoa1406459

PMID:26488692

Abstract

BACKGROUND

Prevention of reinfection and resurgence is an integral component of the goal to eradicate malaria. However, the adverse effects of malaria resurgences are not known.

METHODS

We assessed the prevalence of Plasmodium falciparum infection among 1819 Mozambican women who delivered infants between 2003 and 2012. We used microscopic and histologic examination and a quantitative polymerase-chain-reaction (qPCR) assay, as well as flow-cytometric analysis of IgG antibody responses against two parasite lines.

RESULTS

Positive qPCR tests for P. falciparum decreased from 33% in 2003 to 2% in 2010 and increased to 6% in 2012, with antimalarial IgG antibody responses mirroring these trends. Parasite densities in peripheral blood on qPCR assay were higher in 2010-2012 (geometric mean [±SD], 409±1569 genomes per microliter) than in 2003-2005 (44±169 genomes per microliter, P=0.02), as were parasite densities in placental blood on histologic assessment (50±39% of infected erythrocytes vs. 4±6%, P<0.001). The malaria-associated reduction in maternal hemoglobin levels was larger in 2010-2012 (10.1±1.8 g per deciliter in infected women vs. 10.9±1.7 g per deciliter in uninfected women; mean difference, -0.82 g per deciliter; 95% confidence interval [CI], -1.39 to -0.25) than in 2003-2005 (10.5±1.1 g per deciliter vs. 10.6±1.5 g per deciliter; difference, -0.12 g per deciliter; 95% CI, -0.67 to 0.43), as was the reduction in birth weight (2863±440 g in women with past or chronic infections vs. 3070±482 g in uninfected women in 2010-2012; mean difference, -164.5 g; 95% CI, -289.7 to -39.4; and 2994±487 g vs. 3117±455 g in 2003-2005; difference, -44.8 g; 95% CI, -139.1 to 49.5).

CONCLUSIONS

Antimalarial antibodies were reduced and the adverse consequences of P. falciparum infections were increased in pregnant women after 5 years of a decline in the prevalence of malaria. (Funded by Malaria Eradication Scientific Alliance and others.).

摘要

背景

预防再感染和疟疾卷土重来是消灭疟疾目标的一个组成部分。然而，疟疾卷土重来的不良后果尚不清楚。

方法

我们评估了在 2003 年至 2012 年间分娩的 1819 名莫桑比克妇女中恶性疟原虫感染的流行率。我们使用显微镜和组织学检查以及定量聚合酶链反应（qPCR）检测，以及针对两种寄生虫系的 IgG 抗体反应的流式细胞术分析。

结果

qPCR 检测的恶性疟原虫阳性率从 2003 年的 33%降至 2010 年的 2%，并在 2012 年上升至 6%，抗疟 IgG 抗体反应与之相符。qPCR 检测外周血寄生虫密度在 2010-2012 年（几何均数[±SD]，409±1569 个基因组/微升）高于 2003-2005 年（44±169 个基因组/微升，P=0.02），组织学评估胎盘血寄生虫密度也较高（50±39%感染红细胞，4±6%，P<0.001）。2010-2012 年母亲血红蛋白水平因疟疾而降低的幅度更大（感染妇女为 10.1±1.8 g/分升，未感染妇女为 10.9±1.7 g/分升；平均差异，-0.82 g/分升；95%置信区间[CI]，-1.39 至-0.25），低于 2003-2005 年（10.5±1.1 g/分升 vs. 10.6±1.5 g/分升；差异，-0.12 g/分升；95% CI，-0.67 至 0.43），出生体重降低的幅度也更大（2010-2012 年有过去或慢性感染的妇女为 2863±440 g，未感染妇女为 3070±482 g；平均差异，-164.5 g；95% CI，-289.7 至-39.4；2003-2005 年为 2994±487 g vs. 3117±455 g；差异，-44.8 g；95% CI，-139.1 至 49.5）。