The University of Queensland, Brisbane, Australia.
Royal Brisbane and Women's Hospital, Brisbane, Australia.
Am J Trop Med Hyg. 2018 Apr;98(4):1113-1119. doi: 10.4269/ajtmh.17-0754. Epub 2018 Feb 8.
Liver dysfunction has long been recognized as a clinical feature of malaria. We have observed delayed elevation in the transaminase portion of liver function tests (LFTs) after treatment in some participants undergoing induced blood stage malaria infection. We sought to determine whether similar LFT elevations occur after naturally acquired infection. We performed a retrospective audit of confirmed cases of and in Queensland, Australia, from 2006 to 2016. All LFT results from malaria diagnosis until 28 days after diagnosis were collected with demographic and clinical information to describe longitudinal changes. The timing of peak LFT elevations was classified as early (0-3 days), delayed (4-11 days), or late (12-28 days) with respect to the day of diagnosis. Among 861 cases with LFT evaluated, an elevated bilirubin level was identified in 12.4% ( = 107/861), whereas elevated alanine transaminase (ALT) and aspartate transaminase levels were observed in 15.1% ( = 130/861) and 14.8% ( = 127/861) of cases, respectively. All peak bilirubin results occurred in the early period, whereas ALT elevations were biphasic, with elevations in the early and delayed periods, with 35.4% ( = 46/130) of cases delayed. Univariate and paired stepwise logistic regression analyses were performed to investigate factors associated with the incidence and timing of transaminase elevation. A raised ALT level at diagnosis was strongly associated with the timing of transaminase elevation. No other demographic, parasitic, or treatment factors were associated. Liver function test abnormalities are likely an inherent although variable aspect of human malaria, and individual-specific factors may confer susceptibility to hepatocyte injury.
肝功能障碍一直被认为是疟疾的一个临床特征。我们观察到，在一些接受诱导性血期疟原虫感染的参与者中，治疗后肝功能试验（LFT）中转氨酶部分的升高出现延迟。我们试图确定在自然感染后是否会发生类似的 LFT 升高。我们对 2006 年至 2016 年澳大利亚昆士兰州确诊的 和 病例进行了回顾性审计。收集了疟疾诊断时直到诊断后 28 天的所有 LFT 结果，并结合人口统计学和临床信息描述了纵向变化。根据诊断日，将 LFT 升高的峰值时间分类为早期（0-3 天）、延迟（4-11 天）或晚期（12-28 天）。在 861 例有 LFT 评估的病例中，有 12.4%（=107/861）存在胆红素升高，15.1%（=130/861）和 14.8%（=127/861）的病例分别存在丙氨酸转氨酶（ALT）和天冬氨酸转氨酶水平升高。所有峰值胆红素结果均发生在早期，而 ALT 升高呈双相，早期和延迟期均有升高，其中 35.4%（=46/130）的病例延迟。进行了单变量和配对逐步逻辑回归分析，以调查与转氨酶升高的发生率和时间相关的因素。诊断时升高的 ALT 水平与转氨酶升高的时间有很强的相关性。没有其他人口统计学、寄生虫或治疗因素与之相关。肝功能试验异常可能是人类疟疾固有的，尽管变化不定的方面，个体特异性因素可能导致肝细胞损伤的易感性。
