Uyoga Sophie, Macharia Alex W, Ndila Carolyne M, Nyutu Gideon, Shebe Mohammed, Awuondo Kennedy O, Mturi Neema, Peshu Norbert, Tsofa Benjamin, Scott J Anthony G, Maitland Kathryn, Williams Thomas N
Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
Blood Adv. 2020 Dec 8;4(23):5942-5950. doi: 10.1182/bloodadvances.2020003015.
Few previous studies have reported the effects of glucose-6-phosphate dehydrogenase (G6PD)-deficiency on child health in Africa. We conducted a case-control study in which cases (n = 6829) were children admitted, for any reason, to Kilifi County Hospital, Kenya, while controls (n = 10 179) were recruited from the surrounding community. Cases were subclassified based on their clinical and laboratory findings at admission. We calculated the prevalence of specific diseases by G6PD c.202 genotype, the only significant cause of G6PD-deficiency in this area, then estimated the association between genotype and admission with specific conditions using logistic regression. Among neonates, the prevalence of jaundice was higher in both G6PD c.202T heterozygotes (40/88; 45.5%; P = .004) and homo/hemizygotes (81/134; 60.5%; P < .0001) than in wild-type homozygotes (157/526; 29.9%). Median bilirubin levels also increased across the groups, being highest (239 mmol/L; interquartile range 96-390 mmol/L) in G6PD c.202T homo/hemizygotes. No differences were seen in admission hemoglobin concentrations or the prevalence of anemia or severe anemia by G6PD c.202 genotype. On case control analysis, G6PD heterozygosity was negatively associated with all-cause hospital admission (odds ratio 0.81; 95% confidence interval 0.73-0.90; P < .0001) and, specifically, admission with either pneumonia or Plasmodium falciparum parasitemia; while, conversely, it was positively associated with Gram-positive bacteremia. G6PD c.202T homo/heterozygosity was positively associated with neonatal jaundice, severe pneumonia, the receipt of a transfusion, and in-patient death. Our study supports the conclusion that G6PD c.202T is a balanced polymorphism in which a selective advantage afforded to heterozygous females against malaria is counterbalanced by increased risks of neonatal jaundice, invasive bacterial infections, and anemia.
此前很少有研究报告葡萄糖-6-磷酸脱氢酶(G6PD)缺乏对非洲儿童健康的影响。我们进行了一项病例对照研究,其中病例组(n = 6829)为因任何原因入住肯尼亚基利菲县医院的儿童,而对照组(n = 10179)则从周边社区招募。病例根据入院时的临床和实验室检查结果进行亚分类。我们通过G6PD c.202基因型计算特定疾病的患病率,该基因型是该地区G6PD缺乏的唯一重要病因,然后使用逻辑回归估计基因型与特定疾病入院之间的关联。在新生儿中,G6PD c.202T杂合子(40/88;45.5%;P = 0.004)和纯合/半合子(81/134;60.5%;P < 0.0001)的黄疸患病率均高于野生型纯合子(157/526;29.9%)。各组的胆红素中位数水平也有所升高,在G6PD c.202T纯合/半合子中最高(239 mmol/L;四分位间距96 - 390 mmol/L)。G6PD c.202基因型在入院时的血红蛋白浓度、贫血或重度贫血患病率方面未观察到差异。在病例对照分析中,G6PD杂合性与全因住院呈负相关(比值比0.81;95%置信区间0.73 - 0.90;P < 0.0001),特别是与肺炎或恶性疟原虫血症入院呈负相关;相反,它与革兰氏阳性菌血症呈正相关。G6PD c.202T纯合/杂合性与新生儿黄疸、重症肺炎、输血接受情况和住院死亡呈正相关。我们的研究支持以下结论:G6PD c.202T是一种平衡多态性,其中杂合女性对疟疾的选择性优势被新生儿黄疸、侵袭性细菌感染和贫血风险增加所抵消。