Galatas Beatriz, Mabote Lurdes, Simone Wilson, Matambisso Gloria, Nhamussua Lidia, Mañú-Pereira María Del Mar, Menéndez Clara, Saute Francisco, Macete Eusebio, Bassat Quique, Alonso Pedro, Aide Pedro
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Malar J. 2017 Jan 19;16(1):36. doi: 10.1186/s12936-016-1674-y.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked hereditary enzymatic abnormality that affects more than 400 million people worldwide. Most deficient individuals do not manifest any symptoms; however, several precipitant agents-such as fava intake, infections, or several drugs-may trigger acute haemolytic anaemia. Countries should be informed of the prevalence of this enzymatic anomaly within their borders, in order to make safe and appropriate national decisions regarding the use of potentially unsafe drugs for G6PD deficient individuals.
A school-based cross-sectional survey was conducted in three districts in Mozambique, namely Manhiça, located in the south; Mocuba in the centre; and Pemba in the northern tip of the country. G6PD deficiency was evaluated using the CareStart™ diagnostic test, and enzyme activity levels were measured through fluorescence spectrophotometry in deficient individuals. Chi squared and ANOVA tests were used to assess prevalence and mean enzyme activity differences, and logistic regression was used to identify risk factors associated to the deficiency.
G6PD deficiency prevalence estimates were lowest in the northern city of Pemba (8.3%) and among Emakhuwas and Shimakondes, and higher in the centre and southern regions of the country (16.8 and 14.6%, respectively), particularly among Elomwes and Xichanganas. G6PD deficiency was significantly more prevalent among male students than females (OR = 1.4, 95% CI 1.0-1.8, p = 0.02), although enzyme activity levels were not different among deficient individuals from either gender group. Finally, median deficiency levels were found to be more severe among the deficient students from the north (0.7 U/gHg [0.2-0.7] p < 0.001) and south (0.7 U/gHg [0.5-2.5]), compared to those from the centre (1.4 U/gHg [0.6-2.1]).
These findings suggest that Mozambique, as a historically high malaria-endemic country has considerable levels of G6PD deficiency, that vary significantly across the country. This should be considered when planning national strategies for the use of licensed drugs that may be associated to haemolysis among G6PD individuals, or prior to the performance of future trials using primaquine and other 8-aminoquinolines derivatives. Registration Number CISM local ethics committee (CIBS-25/013, 4th of December 2013), and the National Ethics Committee of Mozambique (IRB00002657, 28th of February 2014).
葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症是一种X连锁遗传性酶异常疾病，全球有超过4亿人受其影响。大多数缺乏该酶的个体没有任何症状；然而，几种诱发因素——如食用蚕豆、感染或某些药物——可能引发急性溶血性贫血。各国应了解本国境内这种酶异常的流行情况，以便就G6PD缺乏个体使用潜在不安全药物做出安全且恰当的国家决策。
在莫桑比克的三个地区开展了一项基于学校的横断面调查，这三个地区分别是位于南部的曼希卡、中部的莫库巴以及该国最北端的奔巴。使用CareStart™诊断测试评估G6PD缺乏症，并通过荧光分光光度法测量缺乏该酶个体的酶活性水平。采用卡方检验和方差分析评估患病率及平均酶活性差异，并使用逻辑回归确定与该缺乏症相关的风险因素。
G6PD缺乏症患病率估计在北部城市奔巴最低（8.3%），在埃马库瓦人和希马孔德人中也较低，而在该国中部和南部地区较高（分别为16.8%和14.6%），尤其是在埃洛姆韦人和西长安加纳斯人中。G6PD缺乏症在男学生中比女学生更普遍（比值比=1.4，95%置信区间1.0-1.8，p=0.02），不过来自两个性别组的缺乏该酶个体的酶活性水平并无差异。最后，发现北部（0.7 U/gHg[0.2-0.7]，p<0.001）和南部（0.7 U/gHg[0.5-2.5]）的缺乏该酶学生的中位数缺乏水平比中部（1.4 U/gHg[0.6-2.1]）的更严重。
这些研究结果表明，作为一个历史上疟疾高流行国家，莫桑比克有相当比例的G6PD缺乏症患者，且全国各地差异显著。在规划可能与G6PD个体溶血相关的许可药物使用的国家战略时，或在使用伯氨喹和其他8-氨基喹啉衍生物进行未来试验之前，应考虑这一点。注册号 顺化医学当地伦理委员会（CIBS-25/013，2013年12月4日）以及莫桑比克国家伦理委员会（IRB00002657，2014年2月28日）。
