Molineaux L, Fleming A F, Cornille-Brøgger R, Kagan I, Storey J
Ann Trop Med Parasitol. 1979 Aug;73(4):301-10. doi: 10.1080/00034983.1979.11687263.
Subjects with sickle cell disease were identified in (i) a whole population sample (2742) Garki District, Kano State, Nigeria, and in (ii) the 534 infants born into the population during five years. Eleven (2.1%) newborn had Hb.SS, as was expected from gene frequency (0.146). Prevalence was maintained in the first year of life, but fell to 0.4% at one to four years and to 0.05% (one person) over the age of nine years. Antimalarial intervention for two transmission seasons was followed by an apparent but not significant decrease in Hb.SS mortality. There was one male aged about 40 years who had Hb.SC (the expected number was three). Hb.SS children were compared to normal subjects at the same age, the same village and the same survey; they had significantly less than the expected Plasmodium malariae infection (P less than 0.01) and lower than median P. falciparum densities while below five years (P less than 0.05). Over one year of age, they tended to have below average indirect fluorescent antibody (IFA) (P less than 0.01), indirect haemagglutinating antibody (IHA) (P less than 0.01) titres and number of precipitin rings (not significant) against P. falciparum antigen, and IFA against P malariae (P less than 0.01). They had above average IgM (P less than 0.05), but their IgG concentrations did not differ from normal. We conclude that (i) sickling is sufficient to protect against P. malariae in Hb.SS but not Hb.AS; (ii) sickling prevents intense P. falciparum infection in Hb.SS, as in Hb.AS; (iii) in Hb.SS, there is less antigenic stimulus and hence less antibody against P. falciparum (like Hb.AS) and P. malariae (unlike Hb.AS); (iv) although less intense, malaria is frequently fatal in Hb.SS, especially in age-group one to four years (unlike Hb.AS); (v) IgM levels are high in Hb.SS in response to frequent infections other than malaria (unlike Hb.AS).
（i）尼日利亚卡诺州加尔基区的整个人口样本（2742人），以及（ii）在五年期间出生于该人群的534名婴儿。11名（2.1%）新生儿患有血红蛋白SS（Hb.SS），这与基因频率（0.146）预期的情况相符。患病率在生命的第一年保持不变，但在1至4岁时降至0.4%，9岁以上降至0.05%（1人）。在两个传播季节进行抗疟干预后，Hb.SS死亡率出现了明显但不显著的下降。有一名约40岁的男性患有血红蛋白SC（Hb.SC）（预期人数为3人）。将Hb.SS儿童与同年龄、同村庄且在同一次调查中的正常受试者进行比较；他们感染间日疟原虫的情况明显少于预期（P<0.01），并且在5岁以下时恶性疟原虫密度低于中位数（P<0.05）。1岁以上时，他们针对恶性疟原虫抗原的间接荧光抗体（IFA）（P<0.01）、间接血凝抗体（IHA）（P<0.01）滴度以及沉淀环数量（不显著）往往低于平均水平，针对间日疟原虫的IFA（P<0.01）也是如此。他们的IgM高于平均水平（P<0.05），但其IgG浓度与正常情况无差异。我们得出以下结论：（i）镰状化足以保护Hb.SS患者免受间日疟原虫感染，但不能保护Hb.AS患者；（ii）镰状化像在Hb.AS患者中一样，可防止Hb.SS患者发生严重的恶性疟原虫感染；（iii）在Hb.SS患者中，针对恶性疟原虫（与Hb.AS患者一样）和间日疟原虫（与Hb.AS患者不同）的抗原刺激较少，因此抗体也较少；（iv）尽管疟疾在Hb.SS患者中程度较轻，但仍经常致命，尤其是在1至4岁年龄组（与Hb.AS患者不同）；（v）由于除疟疾外频繁感染，Hb.SS患者的IgM水平较高（与Hb.AS患者不同）。
