Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, 01 Augusto Correa Street, Guama, Belem, PA, 66075-900, Brazil.
Postgraduate Program in Pharmaceutical Sciences, Institute of Health Sciences, Federal University of Pará, Belém, Brazil.
BMC Infect Dis. 2020 Jun 23;20(1):442. doi: 10.1186/s12879-020-05107-2.
Cerebral malaria is the most severe form of infection with Plasmodium falciparum characterized by a highly inflammatory response. This systematic review aimed to investigate the association between TNF-α levels and cerebral malaria.
This review followed the Preferred Reporting of Systematic Review and Meta-analyses (PRISMA) guidelines. The search was performed at PubMed, LILACS, Scopus, Web of Science, The Cochrane Library, OpenGrey and Google Scholar. We have included studies of P. falciparum-infected humans with or without cerebral malaria and TNF-α dosage level. All studies were evaluated using a risk of bias tool and the GRADE approach.
Our results have identified 2338 studies, and 8 articles were eligible according to this systematic review inclusion criteria. Among the eight articles, five have evaluated TNF- α plasma dosage, while two have evaluated at the blood and one at the brain (post-Morten). Among them, only five studies showed higher TNF-α levels in the cerebral malaria group compared to the severe malaria group. Methodological problems were identified regarding sample size, randomization and blindness, but no risk of bias was detected.
Although the results suggested that that TNF-α level is associated with cerebral malaria, the evidence is inconsistent and imprecise. More observational studies evaluating the average TNF-alpha are needed.
脑型疟疾是最严重的恶性疟原虫感染形式，其特征是高度炎症反应。本系统评价旨在探讨 TNF-α 水平与脑型疟疾之间的关系。
本综述遵循系统评价和荟萃分析的首选报告（PRISMA）指南。在 PubMed、LILACS、Scopus、Web of Science、The Cochrane Library、OpenGrey 和 Google Scholar 进行了检索。我们纳入了有或无脑型疟疾的恶性疟原虫感染人类的研究，并检测了 TNF-α 的剂量水平。所有研究均使用偏倚风险工具和 GRADE 方法进行评估。
我们的研究结果确定了 2338 项研究，根据本系统评价的纳入标准，有 8 篇文章符合条件。在这 8 篇文章中，有 5 篇评估了 TNF-α 血浆剂量，有 2 篇评估了血液中的 TNF-α，1 篇评估了大脑（死后）中的 TNF-α。其中，只有 5 项研究表明脑型疟疾组的 TNF-α 水平高于严重疟疾组。在样本量、随机化和盲法方面存在方法学问题，但未发现偏倚风险。
尽管结果表明 TNF-α 水平与脑型疟疾相关，但证据不一致且不精确。需要更多评估平均 TNF-α 的观察性研究。
