伯氨喹治疗葡萄糖-6-磷酸脱氢酶缺乏症疟疾患者溶血风险的荟萃分析  

Hemolysis risk of primaquine in malaria patients with glucose-6-phosphate dehydrogenase deficiency:a meta-analysis

作　　者：彭书杰 伍国俊[1] 赵会民[1] PENG Shujie;WU Guojun;ZHAO Huimin(Department of General Practice,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530000,China)

机构地区：[1]广西医科大学第二附属医院全科,南宁530000

出　　处：《中国感染与化疗杂志》2022年第5期556-562,共7页Chinese Journal of Infection and Chemotherapy

基　　金：广西医科大学第二附属医院科研项目(EFYKY2020010)。

摘　　要：目的评估不同剂量伯氨喹治疗葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症疟疾患者溶血风险。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、the Cochrane Infectious Diseases Group(CIDG)、中国知网、万方以及维普等中英文数据库,收集G-6-PD缺乏症单疗程或短期疗程使用伯氨喹的相关文献,检索时限为建库至2021年7月30日,采用RevMan 5.4软件进行统计学分析。结果共纳入7篇文献,其中290例G-6-PD缺乏症患者,1022例酶活性正常患者。分析结果显示:与安慰剂相比,不同剂量伯氨喹治疗疟疾患者G-6-PD缺乏症第7天,血红蛋白水平均有不同程度降低;但高剂量治疗组血红蛋白较基线下降百分比更大(P<0.05),中度及以上贫血风险显著增大(RR=4.50,95%CI:2.29~8.84,P<0.0001);中剂量治疗组血红蛋白较基线下降百分比略小于酶活性正常患者(MD=-4.99%,95%CI:-9.96%~-0.02%,P=0.05),但与安慰剂组相比,血红蛋白较基线下降百分比差异无统计学意义(MD=-1.52%,95%CI:-7.73%~4.69%,P=0.63);而低剂量治疗组血红蛋白较基线下降百分比、中度及以上贫血风险差异无统计学意义。结论高剂量伯氨喹治疗G-6-PD缺乏症疟疾患者诱发溶血风险高于中低剂量,尤其是低剂量更加安全。Objective To evaluate the risk of hemolysis induced by different doses of primaquine during treatment in malaria patients with glucose-6-phosphate dehydrogenase(G-6-PD)deficiency.Methods PubMed,Embase,Web of Science,Cochrane Library,the Cochrane Infectious Diseases Group(CIDG)Specialized Register,China National Knowledge Infrastructure(CNKI),Wanfang and VIP databases were searched from the inception of each database up to July 30,2021 to retrieve the relevant references regarding single cycle or short course of primaquine treatment in patients with malaria and G-6-PD deficiency.The data were extracted by two of the authors independently.Software RevMan 5.4 was used to conduct meta-analysis.Results Seven references were included in this analysis,involving 290 patients with G-6-PD deficiency and 1022 patients with normal G-6-PD activity.Compared with placebo,different doses of primaquine treatment reduced hemoglobin level to varying degrees by day 7 in malaria patients with G-6-PD deficiency.Greater percent hemoglobin reduction from baseline was observed in the high-dose primaquine treatment group(P<0.05),associated with significantly higher risk of moderate or even severe anemia(RR=4.50,95%CI:2.29 to 8.84,P<0.0001).The percent hemoglobin reduction from baseline was slightly lower in the medium-dose primaquine treatment group compared to that in the patients with normal G-6-PD activity(MD=-4.99%,95%CI:-9.96%to-0.02%,P=0.05),but was not different significantly from the change in placebo group(MD=-1.52%,95%CI:-7.73%to 4.69%,P=0.63).The percent hemoglobin reduction from baseline and the associated risk of anemia in the low-dose primaquine treatment group did not show significant difference from placebo group.Conclusions Higher dose of primaquine treatment may induce higher risk of hemolysis than low to medium dose in malaria patients with G-6-PD deficiency.

关 键 词：伯氨喹 葡萄糖-6-磷酸脱氢酶缺乏症 疟疾 溶血 荟萃分析 

分 类 号：R531.3[医药卫生—内科学]