Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Defence Services Medical Academy, Yangon, Myanmar.
Malar J. 2023 May 1;22(1):143. doi: 10.1186/s12936-023-04559-6.
Over the past decade, the incidence of malaria has steadily declined in Myanmar, with Plasmodium vivax becoming predominant. The resilience of P. vivax to malaria control is attributed to the parasite's ability to form hypnozoites in the host's liver, which can cause relapse. Primaquine is used to eliminate hypnozoites but can cause haemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals. It is thus necessary to estimate the frequency and variant types of G6PD deficiency in areas where primaquine will be widely used for P. vivax elimination.
In this study, a descriptive cross-sectional survey was conducted to determine the prevalence of G6PD deficiency in a population residing in Nay Pyi Taw, Myanmar, using a standard spectrophotometric assay, a rapid diagnostic test (RDT), Biosensor, and by genotyping G6PD variants.
G6PD enzyme activity was determined from 772 leukocyte-depleted samples, with an adjusted male median G6PD activity value of 6.3 U/g haemoglobin. Using a cut-off value of 30% enzyme activity, the overall prevalence of G6PD deficiency was 10.8%. Genotyping of G6PD variants was performed for 536 samples, of which 131 contained mutations. The Mahidol variant comprised the majority, and males with the Mahidol variant showed lower G6PD enzyme activity. The G6PD Andalus variant, which has not been reported in Myanmar before, was also identified in this study.
This study provides a G6PD enzyme activity reference value for the Myanmar population and further information on the prevalence and variants of G6PD deficiency among the Myanmar population; it also evaluates the feasibility of G6PD deficiency tests.
过去十年中，缅甸的疟疾发病率稳步下降，间日疟原虫成为主要病原体。间日疟原虫对疟疾控制的抵抗力归因于寄生虫在宿主肝脏中形成休眠子的能力，这可能导致复发。伯氨喹用于消除休眠子，但在葡萄糖-6-磷酸脱氢酶（G6PD）缺乏的个体中会引起溶血。因此，有必要在广泛使用伯氨喹消除间日疟原虫的地区估计 G6PD 缺乏的频率和变体类型。
本研究采用标准分光光度法、快速诊断试验（RDT）、生物传感器和基因分型 G6PD 变体，对缅甸内比都居民进行了描述性横断面调查，以确定 G6PD 缺乏症的流行率。
从 772 个白细胞耗尽样本中测定 G6PD 酶活性，调整后的男性中位 G6PD 活性值为 6.3 U/g 血红蛋白。使用 30%酶活性的截断值，G6PD 缺乏症的总患病率为 10.8%。对 536 个样本进行了 G6PD 变体基因分型，其中 131 个样本含有突变。主要是 Mahidol 变体，携带 Mahidol 变体的男性 G6PD 酶活性较低。本研究还发现了以前在缅甸没有报道过的 G6PD Andalusia 变体。
本研究为缅甸人群提供了 G6PD 酶活性参考值，并进一步了解了缅甸人群中 G6PD 缺乏症的流行率和变体情况；还评估了 G6PD 缺乏检测的可行性。
