Biemba G, Gordeuk V R, Thuma P E, Mabeza G F, Weiss G
Macha Mission Hospital, Choma, Zambia.
Trop Med Int Health. 1998 Jan;3(1):60-5. doi: 10.1046/j.1365-3156.1998.00168.x.
To determine if prolonged immune activation may be associated with the persistence of anaemia after treatment for severe malaria, we measured serum concentrations of neopterin and interleukin-4 during one week of antimalarial therapy and determined haemoglobin levels one month later. Neopterin is a clinically valuable marker for monitoring activation of macrophages by gamma-interferon and thus reflects the TH-1 immune response. Interleukin-4 is a major cytokine that tends to be inhibited by TH-1 activity.
The study population consisted of 26 Zambian children < 6 years of age who presented with cerebral malaria to a rural hospital in 1994 and who were treated with quinine for seven days. Six children (23%) were anaemic (haemoglobin < 11 g/dl) one month after completing antimalarial therapy.
On admission, concentrations of neopterin were markedly elevated in all patients. During the seven days of anti-malarial therapy, neopterin levels remained elevated in the 6 children who proved to have persistent anaemia one month after finishing treatment but declined significantly (P = 0.008) in the 20 children who corrected their haemoglobin levels by that time. Conversely, interleukin-4 levels declined in the children with persistent anaemia (P = 0.043) but not in the other children.
Persistence of the TH-1 mediated immune response and associated activation of macrophages may be involved in the pathogenesis of lingering anaemia after treatment of malaria.
为了确定长期免疫激活是否可能与重症疟疾治疗后贫血持续存在相关，我们在抗疟治疗一周期间测量了新蝶呤和白细胞介素-4的血清浓度，并在一个月后测定了血红蛋白水平。新蝶呤是监测γ-干扰素激活巨噬细胞的一种具有临床价值的标志物，因此反映了TH-1免疫反应。白细胞介素-4是一种主要的细胞因子，其活性往往受到TH-1的抑制。
研究对象为1994年在一家乡村医院因脑型疟疾就诊的26名6岁以下赞比亚儿童，他们接受了7天的奎宁治疗。在完成抗疟治疗一个月后，6名儿童（23%）出现贫血（血红蛋白<11 g/dl）。
入院时，所有患者的新蝶呤浓度均显著升高。在抗疟治疗的7天中，在完成治疗一个月后被证明贫血持续存在的6名儿童中，新蝶呤水平仍然升高，但在那时血红蛋白水平已恢复正常的20名儿童中，新蝶呤水平显著下降（P = 0.008）。相反，贫血持续存在的儿童白细胞介素-4水平下降（P = 0.043），而其他儿童则未下降。
TH-1介导的免疫反应持续存在及相关巨噬细胞激活可能参与疟疾治疗后贫血迁延不愈的发病机制。
