Mordmüller B, Kremsner P G
Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, Germany.
Clin Infect Dis. 1998 Apr;26(4):850-2. doi: 10.1086/513926.
A substantial number of reports of cases and small investigations support blood exchange transfusion as a therapy for hyperparasitemia in cases of Plasmodium falciparum malaria, although a prospective and randomized study has never been undertaken. We report on 113 prospectively enrolled children in Lambaréné, Gabon, who had more than 10% parasitized erythrocytes and were treated with chemotherapy alone. All 86 patients with hyperparasitemia as the sole complication recovered uneventfully. Among the 27 patients who had additional complications, parasitemia levels as high as 81% responded well to chemotherapy alone. Two patients with cerebral malaria, who also had other complications and hence a poor prognosis, died. Hyperparasitemia itself might be important for the development of a fatal event in malaria, but a recommendation to perform a dangerous, expensive, and labor-intensive procedure such as blood exchange transfusion for its treatment should be based on substantial clinical research, especially in areas where malaria is a major health problem.
大量的病例报告和小型调查支持换血疗法可用于治疗恶性疟原虫疟疾的高疟原虫血症，尽管尚未进行过前瞻性随机研究。我们报告了在加蓬兰巴雷内前瞻性招募的113名儿童，他们的疟原虫感染红细胞超过10%，仅接受了化疗。所有86例以高疟原虫血症为唯一并发症的患者均顺利康复。在27例有其他并发症的患者中，高达81%的疟原虫血症水平对单纯化疗反应良好。两名患有脑型疟疾且还有其他并发症、预后较差的患者死亡。高疟原虫血症本身可能对疟疾致命事件的发生很重要，但对于像换血疗法这样危险、昂贵且劳动强度大的治疗方法提出建议，应基于大量的临床研究，尤其是在疟疾是主要健康问题的地区。
