Hoffman S L, Rustama D, Punjabi N H, Surampaet B, Sanjaya B, Dimpudus A J, McKee K T, Paleologo F P, Campbell J R, Marwoto H
U. S. Naval Medical Research Unit Number 2, Jakarta Detachment, Indonesia.
J Infect Dis. 1988 Aug;158(2):325-31. doi: 10.1093/infdis/158.2.325.
We compared placebo and dexamethasone (initial dose, 3 mg/kg; total, 11.4 mg/kg per 48 h) in a double-blind trial involving 10 stuporous and 28 comatose patients with cerebral malaria. Patients were 18 mo to 42 y of age (geometric mean, 10.2 y), and the 19 patients in each group were comparable on admission. All patients received intravenous quinine therapy. Four patients (21%) in each group died. There were no significant differences between the placebo- and dexamethasone-treated groups in time until patients became afebrile (median, 51 vs. 19 h), the level of consciousness became normal (mean, 80 vs. 83 h), or parasitemia was cleared (mean, 2.1 vs. 3.4 d) or in the incidence of complications. Coma or hyperparasitemia (greater than or equal to 5% of erythrocytes parasitized) at the time of admission and hypoglycemia at any time during hospitalization were significantly correlated with a fatal outcome, which was not improved by using dexamethasone. We conclude that high-dose dexamethasone is not indicated for treating cerebral malaria.
在一项双盲试验中，我们对安慰剂和地塞米松（初始剂量3mg/kg；每48小时总量11.4mg/kg）进行了比较，该试验纳入了10名昏睡和28名昏迷的脑型疟疾患者。患者年龄在18个月至42岁之间（几何平均数为10.2岁），每组19名患者入院时情况相当。所有患者均接受静脉注射奎宁治疗。每组有4名患者（21%）死亡。在患者退热时间（中位数分别为51小时和19小时）、意识水平恢复正常时间（平均数分别为80小时和83小时）、疟原虫血症清除时间（平均数分别为2.1天和3.4天）或并发症发生率方面，安慰剂治疗组和地塞米松治疗组之间没有显著差异。入院时昏迷或高疟原虫血症（寄生红细胞大于或等于5%）以及住院期间任何时候的低血糖与致命结局显著相关，使用地塞米松并不能改善这种情况。我们得出结论，高剂量地塞米松不适用于治疗脑型疟疾。
