Kurth Florian, Lingscheid Tilman, Steiner Florian, Stegemann Miriam S, Bélard Sabine, Menner Nikolai, Pongratz Peter, Kim Johanna, von Bernuth Horst, Mayer Beate, Damm Georg, Seehofer Daniel, Salama Abdulgabar, Suttorp Norbert, Zoller Thomas
Emerg Infect Dis. 2016 Aug;22(8):1381-6. doi: 10.3201/eid2208.151905.
Episodes of delayed hemolysis 2-6 weeks after treatment of severe malaria with intravenous artesunate have been described. We performed a prospective observational study of patients with uncomplicated malaria to investigate whether posttreatment hemolysis also occurs after oral artemisinin-based combination therapy. Eight of 20 patients with uncomplicated malaria who were given oral artemisinin-based combination therapy met the definition of posttreatment hemolysis (low haptoglobin level and increased lactate dehydrogenase level on day 14). Five patients had hemolysis persisting for 1 month. Patients with posttreatment hemolysis had a median decrease in hemoglobin level of 1.3 g/dL (interquartile range 0.3-2.0 g/dL) in the posttreatment period, and patients without posttreatment hemolysis had a median increase of 0.3 g/dL (IQR -0.1 to 0.7 g/dL; p = 0.002). These findings indicate a need for increased vigilance for hemolytic events in malaria patients, particularly those with predisposing factors for anemia.
静脉注射青蒿琥酯治疗重症疟疾后2至6周出现延迟溶血的病例已有报道。我们对非复杂性疟疾患者进行了一项前瞻性观察研究，以调查基于青蒿素的联合口服疗法治疗后是否也会发生治疗后溶血。在接受基于青蒿素联合口服疗法的20例非复杂性疟疾患者中，有8例符合治疗后溶血的定义（第14天血清结合珠蛋白水平低且乳酸脱氢酶水平升高）。5例患者溶血持续1个月。治疗后发生溶血的患者在治疗后血红蛋白水平中位数下降1.3 g/dL（四分位间距0.3 - 2.0 g/dL），而未发生治疗后溶血的患者血红蛋白水平中位数升高0.3 g/dL（四分位间距 -0.1至0.7 g/dL；p = 0.002）。这些发现表明，需要提高对疟疾患者溶血事件的警惕性，尤其是那些有贫血易感因素的患者。
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