促炎和抗炎细胞因子介导疟疾感染儿童严重贫血的进展：一项前瞻性研究。
Pro- and anti-inflammatory cytokines mediate the progression of severe anemia in malaria-infected children: A prospective study.
机构信息
Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Ebonyi State University, Abakaliki, Nigeria.
出版信息
Immun Inflamm Dis. 2024 Sep;12(9):e70013. doi: 10.1002/iid3.70013.
BACKGROUND
Severe Plasmodium falciparum malarial anemia is still the principal cause of death in children in underdeveloped countries. An imbalance between proinflammatory and anti-inflammatory cytokines is associated with malaria progression. This study evaluated circulating levels of selected inflammatory cytokines among malaria-infected children in Ghana.
METHODS
This case-control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty children with malaria and 60 controls, aged 12-144 months were selected from April to July, 2023 for the study. Malaria was diagnosed through microscopy, full blood count was measured using hematology analyzer, and cytokines were measured using enzyme-linked immunosorbent assay.
RESULTS
Malaria-infected children had higher tumor necrosis factor alpha (TNF-α) (p < .001), interferon-gamma (IFN-ɣ) (p < .001), interleukin (IL)-1β (p < .001), IL-6 (p < .001), granulocyte macrophage-colony stimulating factor (GM-CSF) (p < .001), and IL-10 (p < .001) levels than controls. Participants with high parasitemia had raised TNF-α (p < .001), IFN-ɣ (p < .001), IL-1β (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but reduced IL-3 (p < .001) and TGF-β (p < .001) than those with low parasitemia. Severe malarial anemic children had elevated TNF-α (p < .001), IFN-ɣ (p < .001), IL-1β (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but lower IL-3 (p < .001) and TGF-β (p < .001) than those with uncomplicated malaria.
CONCLUSION
Parasite density was the principal predictor of the cytokine levels, as parasitemia positively associated with IL-10, GM-CSF, IL-6, IL-1β, IFN-ɣ, and TNF-α, but negatively associated with IL-3 and TGF-β. Malaria is associated with enhanced secretion of pro- and anti-inflammatory cytokines in Ghanaian children. Inflammatory cytokines may be involved in the development of severe malarial anemia in children. However, IL-3 and TGF-β may offer protection against severe malarial anemia.
背景
在欠发达国家，严重的恶性疟原虫疟疾仍然是儿童死亡的主要原因。促炎细胞因子和抗炎细胞因子之间的失衡与疟疾的进展有关。本研究评估了加纳疟疾感染儿童循环中选定的炎症细胞因子水平。
方法
本病例对照研究在加纳的塔马利教学医院进行。2023 年 4 月至 7 月期间，选择了 120 名患有疟疾的儿童和 60 名年龄在 12-144 个月的对照者进行研究。通过显微镜诊断疟疾，使用血液学分析仪测量全血细胞计数，使用酶联免疫吸附试验测量细胞因子。
结果
疟疾感染儿童的肿瘤坏死因子-α（TNF-α）（p<0.001）、干扰素-γ（IFN-γ）（p<0.001）、白细胞介素-1β（IL-1β）（p<0.001）、白细胞介素-6（IL-6）（p<0.001）、粒细胞巨噬细胞集落刺激因子（GM-CSF）（p<0.001）和白细胞介素-10（IL-10）（p<0.001）水平均高于对照组。高寄生虫血症的参与者 TNF-α（p<0.001）、IFN-γ（p<0.001）、IL-1β（p<0.001）、IL-6（p<0.001）、GM-CSF（p<0.001）和 IL-10（p<0.001）升高，但 IL-3（p<0.001）和 TGF-β（p<0.001）降低。严重的恶性贫血儿童的 TNF-α（p<0.001）、IFN-γ（p<0.001）、IL-1β（p<0.001）、IL-6（p<0.001）、GM-CSF（p<0.001）和 IL-10（p<0.001）升高，但 IL-3（p<0.001）和 TGF-β（p<0.001）降低。与无并发症的疟疾相比。
结论
寄生虫密度是细胞因子水平的主要预测因素，因为寄生虫血症与 IL-10、GM-CSF、IL-6、IL-1β、IFN-γ和 TNF-α呈正相关，与 IL-3 和 TGF-β呈负相关。疟疾与加纳儿童促炎和抗炎细胞因子的过度分泌有关。细胞因子可能参与儿童严重疟疾贫血的发生。然而，IL-3 和 TGF-β可能提供对严重疟疾贫血的保护。
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