在撒哈拉以南非洲国家停止使用氯喹治疗单纯性疟疾后，对氯喹耐药恶性疟原虫的分子监测：一项系统评价。

Molecular surveillance of chloroquine-resistant Plasmodium falciparum in sub-Saharan African countries after withdrawal of chloroquine for treatment of uncomplicated malaria: A systematic review.

作者信息

Njiro Belinda J, Mutagonda Ritah F, Chamani Amisa T, Mwakyandile Tosi, Sabas Deodatus, Bwire George M

机构信息

Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.

出版信息

J Infect Public Health. 2022 May;15(5):550-557. doi: 10.1016/j.jiph.2022.03.015. Epub 2022 Mar 29.

DOI:10.1016/j.jiph.2022.03.015

PMID:35447389

Abstract

BACKGROUND

A wide spread of chloroquine resistance prompted its discontinued use for treatment of uncomplicated malaria in several African countries. However, disappearances of chloroquine-resistant parasites have been reported in areas with restricted use of chloroquine. This review reports the current prevalence of chloroquine-resistant Plasmodium falciparum using Pfcrt K76T and Pfmdr1 N86Y genotypes.

METHODS

A PROSPERO registered systematic review searched evidence from PubMed/MEDLINE, Science Direct and Google Scholar. The search included studies on chloroquine-resistant/ susceptible P. falciparum in humans between January 1st, 2000 and May 15th, 2020. The search was conducted on 15th of May, 2020.

RESULTS

Out of 519 searched records, 15 studies qualified for final analysis with 8040 samples genotyped for Pfcrt K76T. Of 8040, 43.6% (837/1572; 95%CI: -0.9 to 88.1%) carried resistant genotypes versus 23.0% (1477/6468; 95%CI: 15.7-30.2%) while for 4698 samples analyzed for Pfmdr1 N86Y, 52.4% (592/1090; 95%CI: 42.3-62.5%) had resistant genotypes versus 25.9% (1314/3608; 95%CI: 5.8-46.0%), before and after chloroquine withdrawal, respectively. The median time since chloroquine withdrawal to data collection was 7.0 (interquartile range: 4.5-13.5) years. Low prevalence of resistant genotypes (Pfcrt K76T) was reported in Zambia (0%) in 2013, Malawi (0.1%) in 2009, Tanzania (0.2%) in 2018 and Madagascar (0.3%) in 2007 with significant variations in the included studies.

CONCLUSIONS

Chloroquine-resistant P. falciparum continues to disappear in countries with withdrawal of chloroquine. Areas with significant susceptible parasites, reintroduction of chloroquine can be considered, preferably in combination with other safe and affordable antimalarials.

摘要

背景

氯喹耐药性的广泛传播促使几个非洲国家停止使用其治疗非复杂性疟疾。然而，在氯喹使用受限的地区已有氯喹耐药寄生虫消失的报道。本综述报告了使用Pfcrt K76T和Pfmdr1 N86Y基因型的耐氯喹恶性疟原虫的当前流行情况。

方法

一项在国际前瞻性系统评价注册库（PROSPERO）注册的系统评价检索了来自PubMed/MEDLINE、科学Direct和谷歌学术的证据。检索纳入了2000年1月1日至2020年5月15日期间关于人类氯喹耐药/敏感恶性疟原虫的研究。检索于2020年5月15日进行。

结果

在检索到的519条记录中，15项研究符合最终分析标准，共8040个样本进行了Pfcrt K76T基因分型。在这8040个样本中，氯喹停用前后，分别有43.6%（837/1572；95%置信区间：-0.9至88.1%）携带耐药基因型，而23.0%（1477/6468；95%置信区间：15.7 - 30.2%）携带敏感基因型；在对4698个样本进行Pfmdr1 N86Y基因分型时，氯喹停用前后，分别有52.4%（592/1090；95%置信区间：42.3 - 62.5%）携带耐药基因型，而25.9%（1314/3608；95%置信区间：5.8 - 46.0%）携带敏感基因型。氯喹停用至数据收集的中位时间为7.0年（四分位间距：4.5 - 13.5年）。2013年赞比亚（0%）、2009年马拉维（0.1%）、2018年坦桑尼亚（0.2%）和2007年马达加斯加（0.3%）报告的耐药基因型（Pfcrt K76T）流行率较低，纳入的研究中存在显著差异。