Ong Ken Ing Cherng, Kosugi Hodaka, Thoeun Sophea, Araki Hitomi, Thandar Moe Moe, Iwagami Moritoshi, Hongvanthong Bouasy, Brey Paul T, Kano Shigeyuki, Jimba Masamine
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic.
BMJ Glob Health. 2017 Aug 19;2(3):e000415. doi: 10.1136/bmjgh-2017-000415. eCollection 2017.
To achieve malaria elimination in the Greater Mekong Subregion (GMS) by 2030, proper case management is necessary. 8-aminoquinolines, such as primaquine, are the only available medicines effective in preventing relapse of the hypnozoite stage of , as well as the onward transmission of . However, primaquine can cause haemolysis in individuals who have glucose-6-phosphate dehydrogenase deficiency (G6PDd). We conducted a systematic review on the reported clinical manifestations of G6PDd to provide a comprehensive overview of the situation in the GMS.
The protocol for this systematic review was registered on PROSPERO: International prospective register of systematic reviews (CRD42016043146). We searched the PubMed/MEDLINE, CINAHL, and Web of Science databases for published articles describing the clinical manifestations of G6PDd in the GMS. We included articles of all study designs from inception until 31 July 2016, reporting the clinical manifestations of G6PDd. We then performed a narrative synthesis of these articles.
We included 56 articles in this review, 45 of which were from Thailand. Haemolysis in G6PD-deficient individuals was caused not only by primaquine but also by other medicines and infections. Other clinical manifestations of G6PDd that were found were favism, neonatal jaundice and chronic non-spherocytic haemolytic anaemia. G6PDd also influenced the clinical presentations of genetic disorders and infections, such as thalassemia and typhoid fever.
As G6PDd also affects the clinical presentations of other infections, the benefits of G6PD testing and proper record keeping transcend those of malaria case management. Therefore, healthcare workers at the community level should be made familiar with complications resulting from G6PDd as these complications extend beyond the scope of malaria.
为在2030年前实现大湄公河次区域（GMS）消除疟疾的目标，恰当的病例管理必不可少。8-氨基喹啉类药物，如伯氨喹，是唯一可有效预防间日疟原虫休眠子阶段复发以及阻止其进一步传播的药物。然而，伯氨喹可导致葡萄糖-6-磷酸脱氢酶缺乏症（G6PDd）患者发生溶血。我们对已报道的G6PDd临床表现进行了系统评价，以全面概述GMS的情况。
本系统评价的方案已在国际前瞻性系统评价注册库PROSPERO（注册号：CRD42016043146）登记。我们在PubMed/MEDLINE、CINAHL和科学网数据库中检索已发表的描述GMS中G6PDd临床表现的文章。我们纳入了从创刊至2016年7月31日所有研究设计类型的报道G6PDd临床表现的文章。然后我们对这些文章进行了叙述性综合分析。
我们纳入了本评价中的56篇文章，其中45篇来自泰国。G6PD缺乏个体的溶血不仅由伯氨喹引起，也由其他药物和感染所致。发现的G6PDd的其他临床表现有蚕豆病、新生儿黄疸和慢性非球形红细胞溶血性贫血。G6PDd还影响了遗传性疾病和感染的临床表现，如地中海贫血和伤寒热。
由于G6PDd也影响其他感染的临床表现，G6PD检测和妥善记录的益处超越了疟疾病例管理的范畴。因此，应让社区层面的医护人员熟悉G6PDd所致的并发症，因为这些并发症超出了疟疾的范围。
