Gordeuk V R, Thuma P E, McLaren C E, Biemba G, Zulu S, Poltera A A, Askin J E, Brittenham G M
Department of Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
Blood. 1995 Jun 1;85(11):3297-301.
To determine if the elevated transferrin saturations found in some patients with severe malaria are associated with an adverse outcome in cerebral malaria, we retrospectively measured baseline saturations in stored serum samples from 81 Zambian children with strictly defined cerebral malaria. The children had been treated with quinine, sulfadox-ine-pyrimethamine, and intravenous infusions of either placebo (n = 39) or the iron chelator, desferrioxamine B (n = 42), in a previously reported trial (Gordeuk et al, N Engl J Med 327:1473, 1992). More than one-third of children in both the placebo- and iron chelator-treated groups had transferrin saturations exceeding 43%, which is 3 standard deviations above the expected mean for age. Among children receiving quinine and placebo, those with elevated transferrin saturations had a delayed estimated median time to recover full consciousness (68.2 hours) compared with those with saturations < or = 43% (25.4 hours; P = .006). The addition of iron chelation to quinine therapy in children with high saturations appeared to hasten recovery (P = .046). We conclude that increased transferrin saturations may be associated with delayed recovery from coma during standard therapy for cerebral malaria and that serum iron and total iron binding capacity should be measured in future studies.
为了确定在一些重症疟疾患者中发现的转铁蛋白饱和度升高是否与脑型疟疾的不良预后相关，我们回顾性测量了81名严格定义为脑型疟疾的赞比亚儿童储存血清样本中的基线饱和度。在之前一项已发表的试验中（Gordeuk等人，《新英格兰医学杂志》327:1473，1992），这些儿童接受了奎宁、磺胺多辛-乙胺嘧啶治疗，以及静脉输注安慰剂（n = 39）或铁螯合剂去铁胺B（n = 42）。安慰剂治疗组和铁螯合剂治疗组中均有超过三分之一的儿童转铁蛋白饱和度超过43%，这比预期年龄均值高出3个标准差。在接受奎宁和安慰剂治疗的儿童中，转铁蛋白饱和度升高的儿童估计恢复完全意识的中位时间延迟（68.2小时），而饱和度≤43%的儿童为25.4小时（P = .006）。在饱和度高的儿童中，奎宁治疗加用铁螯合似乎能加速恢复（P = .046）。我们得出结论，转铁蛋白饱和度升高可能与脑型疟疾标准治疗期间昏迷恢复延迟有关，未来研究应测量血清铁和总铁结合力。
