Thuma P E, Mabeza G F, Biemba G, Bhat G J, McLaren C E, Moyo V M, Zulu S, Khumalo H, Mabeza P, M'Hango A, Parry D, Poltera A A, Brittenham G M, Gordeuk V R
Pennsylvania State University, Hershey Medical Center, USA.
Trans R Soc Trop Med Hyg. 1998 Mar-Apr;92(2):214-8. doi: 10.1016/s0035-9203(98)90753-2.
To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age < 6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18.3% (32/175) in the deferoxamine group and 10.7% (19/177) in the placebo group (adjusted odds ratio 1.8; 95% confidence interval 0.9-3.6; P = 0.074). At the rural study site, mortality was 15.4% (18/117) with deferoxamine compared to 12.7% (15/118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24.1% (14/58) with deferoxamine and 6.8% (4/59) with placebo (P = 0.061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1.2; 95% confidence interval 0.97-1.6; P = 0.089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.
为研究铁螯合对脑型疟疾死亡率的影响，我们在赞比亚的两个中心（一个农村中心和一个城市中心）开展了一项试验，将352名儿童纳入除标准奎宁治疗外还使用去铁胺的研究。入选标准包括年龄小于6岁、恶性疟原虫血症、脑脊液正常以及昏迷无法唤醒。去铁胺（100mg/kg/天，共输注72小时）或安慰剂被添加到包含负荷剂量的7天奎宁治疗方案中。去铁胺组的总体死亡率为18.3%（32/175），安慰剂组为10.7%（19/177）（调整后的优势比为1.8；95%置信区间为0.9 - 3.6；P = 0.074）。在农村研究地点，使用去铁胺的死亡率为15.4%（18/117），而使用安慰剂的死亡率为12.7%（15/118）（P = 0.78，经协变量调整）。在城市地点，使用去铁胺的死亡率为24.1%（14/58），使用安慰剂的死亡率为6.8%（4/59）（P = 0.061，经协变量调整）。在幸存者中，去铁胺组从昏迷中恢复更快的趋势不显著（调整后的优势比为1.2；95%置信区间为0.97 - 1.6；P = 0.089）。肝肿大与较高死亡率显著相关，而脾肿大与较低死亡率相关。在包含负荷剂量的治疗方案中，当在奎宁中添加去铁胺时，本研究未提供对脑型疟疾患儿死亡率有有益影响的证据。
