我国恶性疟原虫对氯喹抗性的消长  

Fluctuation in the Resistance of Plasmodium falciparum to Chloroquine in China

作　　者：刘德全[1] 冯晓平[1] 杨恒林[2] 林世干[3] 陈文江[3] 杨品芳[2] 

机构地区：[1]中国疾病预防控制中心寄生虫病预防控制所,上海200025 [2]云南省寄生虫病防治所,思茅665000 [3]海南省疾病预防控制中心,海口570203

出　　处：《中国寄生虫学与寄生虫病杂志》2005年第1期27-31,共5页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：目的　监测停止或减少使用氯喹防治恶性疟后恶性疟原虫对氯喹抗性的变化。　方法　采用世界卫生组织 (WHO)制定的体外微量法和体内四周法 ,在停用氯喹后不同时间测定恶性疟原虫对氯喹的敏感性。　结果　海南省乐东县抱由镇体外法测定抗性率由 1981年的 97 9%降至 1997年的 2 6 7% (P <0 0 1) ,完全抑制裂殖体形成的平均药浓度由 10 46± 7 14 pmol/μl血 降至 1 63± 1 47pmol/μl血 (P <0 0 1) ,用较高药浓度 (>6 4pmol/μl血)才能完全抑制裂殖体形成的病例所占比例由 83 3 %降为 6 7% (P <0 0 1)。体内法测定抗性率由 1981年的 84 2 %降为 1997年的 18 4% (P <0 0 1) ,三级抗性 (RⅢ )占抗性病例的比例由 5 3 1%降为 14 3 % (P <0 0 1) ,血中无性体疟原虫平均消失时间由 72 0± 2 1 6h变为 5 0 7± 16 1h。2 0 0 1年三亚市雅亮乡体外法测定抗性率为 5 9 8% ,平均抑制药浓度 3 5 6± 2 12 pmol/μl血 。 2 0 0 3年乐东县福抱乡体内法测定抗性率为 62 5 % ,RI、RⅡ和RⅢ分别占抗性病例 5 0 %、 3 0 %和 2 0 % ,无性体疟原虫平均消失时间 5 6 9± 17 2h。云南省勐腊县体外法测定抗性率由 1981年的97 4%降至 1999年的 77 8% (P <0 0 1) ,完全抑制裂殖体形成的平均药物浓度由 17 2± 12Objective To investigate whether chloroquine-resistance of Plasmodium falciparum had changed after stopping or reducing the use of chloroquine as an antimalarial in Hainan and Yunnan provinces. Methods WHO standard in vitro microtest and 4-week in vivo test were used, assays were carried out in different time after stopping or reducing the use of chloroquine. Results In vitro test in Hainan indicated that the rate of chloroquine-resistant P.falciparum was 97 ^9% in 1981, and dropped to 26 ^7% in 1997(P<0 ^01). The mean concentration of chloroquine for complete inhibition of schizont formation was 10 ^46±7 ^14 pmol/μl blood in 1981, decreased to 1 ^63±1 ^47 pmol/μl blood in 1997(P<0 ^01). The proportion of samples taken from malaria cases that required high concentration (>6 ^4 pmol/μl blood ) of chloroquine for complete inhibition of schizont formation was 83 ^3% in 1981 and only 6 ^7% in 1997(P<0 ^01). In the 4-week in vivo test, the rate of chloroquine-resistant P.falciparum decreased from 84 ^2% in 1981 to 18 ^4% in 1997(P<0 ^01). RⅢ cases accounted for 53 ^1% of the total resistant cases in 1981, and for 14 ^3% in 1997(P<0 ^01). In vitro test in Yunnan revealed that the rate of chloroquine-resistant P.falciparum, the mean concentration of chloroquine for complete inhibition of schizont formation and the proportion of samples taken from malaria cases that required>6 ^4 pmol/μl blood of chloroquine for complete inhibition of schizont formation were 97 ^4%, 17 ^2±12 ^6 pmol/μl blood and 58 ^9% in 1981 respectively, and dropped to 70 ^4%(P<0 ^01), 4 ^0±3 ^3 pmol/μl blood(P<0 ^01) and 16 ^6%(P<0 ^01) in 2002 respectively. Conclusion The resistance of P.falciparum to chloroquine declined progressively after its use had been stopped or reduced in Hainan and Yunnan provinces.

关 键 词：恶性疟原虫 氯喹抗性 体内 抑制 性病 药物浓度 病例 体外法 体形 消长 

分 类 号：R382.31[医药卫生—医学寄生虫学] R531.3[医药卫生—基础医学]