双氢青蒿素与咯萘啶伍用治疗抗性恶性疟的研究  

Study on Treatment of Multi-drug Resistant Falciparum Malaria by Using a Combination of Dihydroartemisinin and Pyronaridine

作　　者：刘德全[1] 林世干[2] 冯晓平[1] 陈文江[2] 陈溥林[1] 吴惠敏[1] 陈昌[1] 柳坚[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 [2]海南省热带病防治研究所,海口570203

出　　处：《中国寄生虫学与寄生虫病杂志》2002年第4期193-196,共4页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：世界卫生组织西太区办事处资助项目 (IDMVP/ CHN/02/01)

摘　　要：目的　寻找更理想的治疗抗药性恶性疟的联合用药方案。　方法　双氢青蒿素、咯萘啶单用及伍用分别治疗 2 4、2 5和 32例恶性疟现症患者 ,分别于服药后第 14、2 1及 2 8天随访 ,以退热时间、原虫消失时间、复燃时间、复燃率、治愈率、配子体携带率、药物副作用发生率等为指标 ,以双氢青蒿素、咯萘啶标准疗法为对照 ,进行临床双盲试验 ,综合评估双氢青蒿素合并咯萘啶疗法。　结果　伍用组退热时间 35 .7± 2 4 .7h与咯萘啶单用组 35 .8± 16 .5 h相似 (P>0 .0 5 ) ,显著快于双氢青蒿素单用组 5 2 .6± 38.9h(P<0 .0 1)。伍用组无性体原虫消失时间 2 3.8± 10 .1h与双氢青蒿素单用组 2 2 .9± 6 .5 h相似 (P>0 .0 5 ) ,显著快于咯萘啶单用组 4 9.4± 2 0 .3h (P<0 .0 1)。伍用组治后配子体出现率、持续时间及密度分别为 2 0 .0 %、5 .7d和 4个 /μl血 ,与双氢青蒿素单用组 16 .7%、3.5 d和 3个 /μl血相似 (P>0 .0 5 ) ,明显好于咯萘啶单用组 6 0 .9%、11.5 d和 12个 /μl血 (P<0 .0 1)。 3种方案均无明显药物副反应。　结论　双氢青蒿素与咯萘啶伍用保持了两药的优点 ,克服了两药的不足 。Objective To provide a combined medication scheme for the treatment of multi-drug resistant falciparum malaria. . Methods. Combined administration of dihydroartemisinin and pyronaridine was given to the 32 cases of falciparum malaria cases with multi-drug resistance. The indices for evaluation on day 14, 21, and 28 after treatment included the mean fever subsidence time, mean asexual form clearance time, mean recrudescence time of asexual form and recrudescence rate, proportion of gametocyte carriers, mean density of gametocytes and its mean clearance time, cure rate and rate of side-effects. A double blind clinical test was performed with standard schemes of dihydroartemisinin (20 cases) and pyronaridine (25 cases) as control. Results . The mean fever subsidence time of treated patients by dihydroartemisinin/pyronaridine combination, dihydroartemisinin and pyronaridine was 35.^7±24.^7 h, 52.^6±38.^9 h and 35.^8±16.^5 h respectively, showing a significant difference between the combination group and dihydroartemisinin groups (P<0.^01). The mean asexual form clearance time was 23.^8±10.^1 h, 22.^9±6.^5 h and 49.^4±20.^3 h respectively, showing significantly faster in the combination group than the pyronaridine group (P<0.^01). The recrudescence rate was 0, 4.^2% and 0 respectively. The proportion of gametocyte carriers was 20.^0%, 16.^7% and 60.^9% respectively, with a significantly higher rate in the group of pyronaridine than the group of combination (P<0.^01).. Conclusion . The combination of dihydroartemsinin and pyronaridine is an ideal medication scheme for the treatment of falciparum malaria cases with multi-drug .{resistance.}.

关 键 词：双氢青蒿素 咯萘啶 恶性疟原虫 抗药性恶性疟 联合用药 

分 类 号：R531.305[医药卫生—内科学]