Lombardo Patrick, Vaucher Paul, Rarau Patricia, Mueller Ivo, Favrat Bernard, Senn Nicolas
Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland.
University Center of Legal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland.
Am J Trop Med Hyg. 2017 Dec;97(6):1770-1776. doi: 10.4269/ajtmh.17-0093. Epub 2017 Sep 21.
Studies are available that assess the risk of malaria in accordance to the body's iron store and the systematic iron supplementation of preschool children. However, only a few studies evaluated the temporal association between hemoglobin and malaria and their results are opposing. A total of 1,650 3-month-old Papua New Guinean infants were enrolled in this study and followed-up for 12 months. The risk of malaria was assessed in all children every 3 months and with each episode of fever. The incidence of clinical malaria between 3 and 15 months of age was 249 cases per 1,000 infants per year. After adjustment for potential confounding factors, a decrease of 1 g/dL of hemoglobin was associated with a nonsignificant increase of 11% for risk of malaria infection (hazard ratio, 1.11, 95% confidence interval; CI, 0.99-1.25, = 0.076). Only children with severe anemia (hemoglobin < 8.0 g/dL) at baseline were at higher risk of malaria infection (hazard ratio, 1.72, 95% CI, 1.08-2.76, = 0.023) during the follow-up year compared with the control group (Hemoglobin > 10.0 g/dL). This association was not statistically significant if only clinical malaria episodes were taken into account (hazard ratio, 1.42, 95% CI, 0.77-2.61, = 0.26). Our study suggests that infants with lower hemoglobin levels are not protected against malaria infection. Further research that examines the risk of malaria in relation to both hemoglobin and iron store levels would be important to better understand this complex interaction.
现有一些研究根据人体的铁储备以及对学龄前儿童进行系统性铁补充的情况来评估疟疾风险。然而，仅有少数研究评估了血红蛋白与疟疾之间的时间关联，且它们的结果相互矛盾。本研究共纳入了1650名3个月大的巴布亚新几内亚婴儿，并对其进行了为期12个月的随访。每3个月以及每次发热发作时，对所有儿童的疟疾风险进行评估。3至15个月龄儿童临床疟疾的发病率为每年每1000名婴儿中有249例。在对潜在混杂因素进行调整后，血红蛋白水平每降低1 g/dL，疟疾感染风险非显著性增加11%（风险比，1.11；95%置信区间，CI：0.99 - 1.25；P = 0.076）。与对照组（血红蛋白>10.0 g/dL）相比，仅基线时患有严重贫血（血红蛋白<8.0 g/dL）的儿童在随访年度感染疟疾的风险更高（风险比，1.72；95% CI，1.08 - 2.76；P = 0.023）。如果仅考虑临床疟疾发作情况，这种关联无统计学意义（风险比，1.42；95% CI，0.77 - 2.61；P = 0.26）。我们的研究表明，血红蛋白水平较低的婴儿并不能预防疟疾感染。进一步研究血红蛋白和铁储备水平与疟疾风险之间的关系，对于更好地理解这种复杂的相互作用至关重要。
