Sylla Khadime, Tine Roger, Sow Doudou, Lelo Souleye, Abiola Annie, NDiaye Jean Louis, NDiaye Magatte, Folly Kuaku, NDiaye Léon Amath, Gaye Oumar, Faye Babacar
Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP de Dakar, Senegal.
J Parasitol Res. 2022 Dec 22;2022:1635791. doi: 10.1155/2022/1635791. eCollection 2022.
Artemisinin-based Combination Therapies (ACTs) are widely used in the treatment of uncomplicated malaria. infection is often accompanied by disturbances of hematological and biochemical parameters. The objective of this study was to evaluate the changes in biochemical and hematological parameters during uncomplicated malaria in patients treated with ACTs.
Data from patient with uncomplicated malaria were pooled from different open-randomized trial evaluating the efficacy of Artesunate-Mefloquine (ASMQ), Artesunate-Amodiaquine (ASAQ), Artemether-Lumefantrine (AL), and Dihydro-artemisinin-Piperaquine (DHAPQ) combinations. Biochemical (transaminases, creatinine, and bilirubin) and hematological (hemoglobin and platelet levels) parameters were performed at baseline (D0) and at day 7 after treatment (D7). Data were analyzed as both continuous and categorical variables with 95% confidence interval. Risks and trends were calculated using multivariate logistic random effect models.
A total of 720 patients with completed biological data were included in the analysis (320 in the AL arm, 160 in the ASMQ arm, 120 in the DHAPQ arm, and 88 in the ASAQ arm). The mean age of the patients was 9.43 ± 9.1 years. Male subjects represented 58.47% (sex ratio was 1.4 for males). The mean hemoglobin level at inclusion (D0) was 9.79 g/dl and anemia (Hb < 11 g/dl) was 71.43% (aOR = 1.16 [0.68 - 1.98] = 0.57). At D7, hemoglobin level was 9.63 g/dl and anemia was significantly more frequent (78.29% [ = 0.002]). The mean platelet count at day 0 was 154075.5 platelets/mm of blood and 339328.7 platelets/mm at day 7. Thrombocytopenia was about 53.61% and was associated with malaria (aOR = 3.4 [2.18 - 5.3] < 10). 19.58% of patients had abnormal ALT and 40.28% had abnormal AST at D0. 27.22% of patients had normal bilirubin at D0. Renal function was normal in all patients in the study. Normalization of transaminases was noted between D0 and D7. The percentage of subjects with normal bilirubin increased between D0 and D7. Renal function did not vary significantly between D0 and D7.
Results from this analysis showed that subjects with high parasitaemia had a greater risk of anemia and thrombocytopenia. Artemisinin combinations were well-tolerated as no major biological disturbances were noted. The effects of ACTs on hematologic and biochemical parameters were not different.
基于青蒿素的联合疗法（ACTs）广泛用于治疗非复杂性疟疾。感染常伴有血液学和生化指标的紊乱。本研究的目的是评估接受ACTs治疗的非复杂性疟疾患者在治疗期间生化和血液学指标的变化。
汇总来自不同开放随机试验中患有非复杂性疟疾患者的数据，这些试验评估了青蒿琥酯-甲氟喹（ASMQ）、青蒿琥酯-阿莫地喹（ASAQ）、蒿甲醚-本芴醇（AL）和双氢青蒿素-哌喹（DHAPQ）联合疗法的疗效。在基线（D0）和治疗后第7天（D7）检测生化指标（转氨酶、肌酐和胆红素）和血液学指标（血红蛋白和血小板水平）。数据作为连续变量和分类变量进行分析，置信区间为95%。使用多变量逻辑随机效应模型计算风险和趋势。
共有720例具有完整生物学数据的患者纳入分析（AL组320例，ASMQ组160例，DHAPQ组120例，ASAQ组88例）。患者的平均年龄为9.43±9.1岁。男性占58.47%（男女比例为1.4）。纳入时（D0）的平均血红蛋白水平为9.79 g/dl，贫血（血红蛋白<11 g/dl）发生率为71.43%（调整后比值比[aOR]=1.16[0.68 - 1.98]=0.57）。在D7时，血红蛋白水平为9.63 g/dl，贫血发生率显著更高（78.29%[P = 0.002]）。第0天的平均血小板计数为154075.5个/立方毫米血液，第7天为339328.7个/立方毫米。血小板减少症发生率约为53.61%，且与疟疾相关（aOR = 3.4[2.18 - 5.3]<0.001）。在D0时，19.58%的患者谷丙转氨酶（ALT）异常，40.28%的患者谷草转氨酶（AST）异常。在D0时，27.22%的患者胆红素正常。研究中所有患者肾功能均正常。在D0和D7之间观察到转氨酶恢复正常。在D0和D7之间，胆红素正常的受试者百分比增加。在D0和D7之间肾功能无显著变化。
该分析结果表明，高寄生虫血症患者贫血和血小板减少的风险更高。青蒿素联合疗法耐受性良好，未观察到重大生物学紊乱。ACTs对血液学和生化指标的影响无差异。
