马里人与在马里华人患危重恶性疟的不同表现与机制探讨  

Analysis of different clinical features and mechanism of falciparum malaria in several patients between Chinese and Malian

作　　者：乔松[1] 屠政良[2] 郑彬荣[3] 王宇军[4] 张剑[5] 金戈[6] 

机构地区：[1]浙江医院ICU,浙江省杭州310013 [2]浙江大学第一附属医院胸外科 [3]浙江省天台县人民医院麻醉科 [4]浙江省立同德医院影像科 [5]浙江大学附属邵逸夫医院骨科 [6]浙江省人民医院药剂科

出　　处：《中华急诊医学杂志》2014年第5期539-542,共4页Chinese Journal of Emergency Medicine

摘　　要：目的对比研究马里人与在马里华人罹患危重恶性疟后的特点，并探讨可能机制。方法对照研究。华人恶性疟患者（n=28）与马里恶性疟患者（n=35）进行对比，分别记录患者基本情况、格拉斯哥昏迷评分（Glasgow coma scale, GCS）、APACHEⅡ评分、呼吸机应用时间及ICU治疗时间、治疗前及治疗后1、3、7 d化验室检查［疟原虫检测、血常规、肝肾功能、C-反应蛋白（CRP）等］、头部CT等检查及病死率，观察疾病特点。结果中马危重恶性疟患者构成不同，马里患者病情严重；疟原虫数量、血常规三系、肝肾功能及CRP水平呈动态变化，马里患者变化较大，APACHEⅡ评分与CRP水平有相关性（r0=0.5，r1=0.6，r3=0.7，r7=0.5）（P〈0.05）；重症患者头部CT可呈局灶性缺血改变；两组病死率分别为16.7%和25.0%。结论中国与马里恶性疟患者人群构成有不同，马里患者病情严重；病情程度可能与感染后机体免疫反应相关。Objective To investigate the clinical features and the mechanism of falciparum malaria in several patients between Chinese and Malian. Methods The data of Chinese （n = 28 ） and Malian patients （ n = 35 ） including general condition, Glasgow Coma Scale （GCS） , APACHE II , the time of applying ventilator and days of stay in ICU, laboratory examination （ plasmodium test, routine blood test, liver and kidney function and C-reactive protein （CRP） assayed before treatment and ld, 3d, 7d after treatment, cranial computed tomography and mortality were recorded for investigating the clinical features of the disease. Results There was difference in age range between Chinese patients （ranged from 32 to 50 years old） and Malian patients （ranged from 8 to 72 years old）, and difference in severity of the disease between patients of two countries was found and Malian patients were more severely infected than Chinese patients. The results of plasmodium test, routine blood test, liver and kidney function and level of CRP often varied greatly during the entire course of the disease, and the changes were greater in Malian patients. The correlation between APACHE 1] and CRP was found （ P 〈 0. 05 ）. The cranial CT displayed iscbemia focus in brain. The mortality of Chinese patients was 16.7% and that of Malian was 25.0%. Conclusions There was difference in composition of residents between Chinese patients and Malian patients. Malian patients were more severely infected with Plasmodium falciparum than Chinese patients, and this difference might be due to the potential correlation between the disease virulence and immune response of patients.

关 键 词：恶性疟 马里 APACHEⅡ C反应蛋白 

分 类 号：R531.3[医药卫生—内科学]