两种氯伯喹方案治疗间日疟急性血管内溶血反应比较观察  

A comparative study of acute intravascular hemolysis in response to two chloroquine-primaquine regimens to treat Plasmodium vivax malaria

作　　者：孙晓东[1,2] 张再兴[2] 邓艳[2] 王剑[2] 魏春[2] 梁桂亮 王恒[1] 

机构地区：[1]中国医学科学院基础医学研究所北京协和医学院基础学院,100005 [2]云南省寄生虫病防治所疟疾防制科,云南普洱665000 [3]昆明市第三人民医院检验科,云南昆明650041

出　　处：《中国病原生物学杂志》2012年第5期390-392,共3页Journal of Pathogen Biology

基　　金：第五轮中国全球基金疟疾项目硕士研究生培养专项基金(No.2007-03)

摘　　要：目的比较氯伯8d疗法与氯伯14d疗法治疗间日疟的安全性,探讨急性血管内溶血与G6PD缺乏之间的关系。方法 2007～2008年,选择缅甸拉咱市及郊区4个自然村为调查点,将单纯间日疟现症患者随机分配到A、B两组,A组采用氯伯8d疗法,即成人氯喹总剂量1 200mg(基质,第1d600mg,第2、3d均为300mg),伯喹总剂量180mg(基质,22.5mg/d×8d);B组采用氯伯14d疗法,即成人氯喹总剂量1 500mg(基质,25mg/kg体重×3d,顿服),伯喹总剂量210mg(基质,0.25mg/kg体重×14d),于投药后的D0、D1、D2、D3、D7、D14、D21和D28随访,观察症状,原虫密度、体温和尿液性状,出现急性黄疸或/和血红蛋白尿为溶血反应阳性。2008年纳入病例用荧光斑点法检测G6PD活性。结果 A组观察62例,1例景颇族病例发生急性血管内溶血,溶血率为1.61%;B组观察56例,均未发生溶血。G6PD活性共检测74例,11例缺乏,总缺乏率为14.87%。其中,A组和B组G6PD缺乏率分别为21.62%(8/37)和8.11%(3/37),差异无统计学意义(χ2=2.67,P>0.05)。A组的1例溶血反应病例G6PD严重缺乏。结论氯伯8d疗法溶血率略高于氯伯14d疗法。溶血可能与G6PD缺乏程度和人群对伯喹耐受程度有关。Objective To compare the safety of an 8-day chloroquine-primaquine regimen and a 14-day chloroquine-primaquine regimen to treat Plasmodium vivax malaria and to explore the relationship between acute intravascular hemolysis（AIH） and glucose-6-phosphate dehydrogenase（G6PD） deficiency.Methods A randomized clinical trial was conducted in the City of Laiza,Myanmar and four suburban villages from 2007 to 2008.Patients infected with P.vivax were recruited and randomly divided into groups A and B.Group A received an 8-day chloroquine-primaquine regimen with a total adult dose of 1200 mg chloroquine（base,600 mg on Day 0,300 mg on Day 1,and 300 mg on Day 2）and 180 mg primaquine（base,22.5 mg primaquine/d×8 d,simultaneously administered with chloroquine on Day 0）.Group B received a 14-day chloroquine-primaquine regimen with a total dose of 1 500 mg chloroquine（base,25 mg chloroquine/kg.body weight×3 d） and 210 mg primaquine（base,0.25 mg primaquine/kg.body weight/d×14 d,simultaneously administered with chloroquine on Day 0）.Patients were followed up on D0,D1,D2,D3,D7,D14,D21 and D28;their symptoms,parasite density,body temperature,and urine were observed.Patients who suffered from jaundice and/or hematuria after treatment were deemed to be positive for AIH.G6PD activity was determined using the fluorescent spot test with dried blood specimens on filter paper that were collected from patients enrolled in 2008.Results There were 62 patients in group A;1 patient from the Jingpo ethnic group developed AIH.The rate of AIH in group A was 1.67%.There were 56 patients in group B,and none developed AIH.G6PD activity was determined in 74 patients;11 had G6PD deficiency.The total rate of G6PD deficiency was 14.87%.The rate of G6PD deficiency was 21.62% in group A and 8.11% in group B.The only patient with AIH in group A was found to have a severe G6PD deficiency.There was no significant difference between groups A and B in terms of the rate of G6PD deficiency（χ^2=2.67,P=0.102）.Conclusion The 8-day regimen

关 键 词：间日疟 氯伯喹方案 治疗 急性血管内溶血 G6PD缺乏 

分 类 号：R531.3[医药卫生—内科学]