Department of Biomedical Science and Technology, School of Pub;ic Health and Community Development, Maseno University, Maseno, Kenya.
Department of Medical Laboratory Sciences, School of Medicine, Kisii University, P.O. Box 408-40200, Kisii, Kenya.
BMC Infect Dis. 2020 Nov 25;20(1):887. doi: 10.1186/s12879-020-05625-z.
Sickle cell disease (SCD) is a monogenic disorder due to point mutation in the β-globin gene resulting in substitution of Valine for Glutamic acid. The SCD is prevalent in P. falciparum endemic regions such as western Kenya. Carriage of different sickle cell genotypes may influence haematological parameter during malaria. Children resident in malaria holoendemic regions suffer more from malaria-related complications and this is moderated by the presence of the SCD. In the current study, we determined the association between sickle cell genotypes and haematological parameters in children with P. falciparum malaria resident in Kisumu County in Western Kenya.
Children (n = 217, aged 1-192 months) with acute febrile condition were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital. Chi-square (χ2) analysis was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Multivariate logistic regression analysis controlling for infection status was used to determine the association between sickle cell genotypes and haematological parameters.
Using HbAA as the reference group, multivariate logistic regression analysis revealed that carriage of HbSS was associated with reduced haemoglobin [OR = 0.310, 95% CI = 0.101-0.956, P = 0.041], reduced haematocrit [OR = 0.318, 95% CI = 0.128-0.793, P = 0.014], reduced RBC count [OR = 0.124, 95% CI = 0.045-0.337, P = 0.001], reduced MCHC [OR = 0.325, 95% CI = 0.118-0.892, P = 0.029], increased leucocytosis [OR = 9.283, 95% CI = 3.167-27.210, P = 0.001] and reduced monocytosis [OR = 0.319, 95% CI = 0.123-0.830, P = 0.019]. However, carriage of HbAS was only associated with increased micro-platelets [OR = 3.629, 95% CI = 1.291-8.276, P = 0.012].
Results show that carriage of HbSS in children influence the levels of haemoglobin, haematocrit, RBC, MCHC, WBC and Monocytes. Therefore prior knowledge of HbSS should be considered to improve clinical management of haematological alterations during malaria in children.
镰状细胞病（SCD）是一种单基因疾病，由于β-珠蛋白基因的点突变导致缬氨酸取代谷氨酸。SCD 在疟疾流行地区如肯尼亚西部很常见。不同镰状细胞基因型的携带可能会影响疟疾期间的血液学参数。居住在疟疾全流行地区的儿童遭受更多的疟疾相关并发症，而 SCD 则会减轻这种影响。在目前的研究中，我们确定了居住在肯尼亚西部基苏木县的患有恶性疟原虫疟疾的儿童中镰状细胞基因型与血液学参数之间的关联。
招募了 217 名年龄在 1-192 个月之间的急性发热儿童，在 Jaramogi Oginga Odinga 教学和转诊医院接受治疗。卡方（χ2）分析用于确定比例之间的差异。使用 Kruskal-Wallis 检验比较各组之间的血液学参数差异，使用 Mann-Whitney U 检验比较组间差异。使用控制感染状态的多变量逻辑回归分析来确定镰状细胞基因型与血液学参数之间的关联。
以 HbAA 为参考组，多变量逻辑回归分析显示，携带 HbSS 与血红蛋白降低有关[比值比（OR）=0.310，95%置信区间（CI）=0.101-0.956，P=0.041]、血细胞比容降低[OR=0.318，95%CI=0.128-0.793，P=0.014]、红细胞计数降低[OR=0.124，95%CI=0.045-0.337，P=0.001]、平均红细胞血红蛋白浓度降低[OR=0.325，95%CI=0.118-0.892，P=0.029]、白细胞增多[OR=9.283，95%CI=3.167-27.210，P=0.001]和单核细胞减少[OR=0.319，95%CI=0.123-0.830，P=0.019]。然而，携带 HbAS 仅与血小板增多有关[OR=3.629，95%CI=1.291-8.276，P=0.012]。
结果表明，儿童携带 HbSS 会影响血红蛋白、血细胞比容、红细胞、平均红细胞血红蛋白浓度、白细胞和单核细胞的水平。因此，在儿童疟疾期间，应考虑到 HbSS 的预先知识，以改善血液学改变的临床管理。
