Clinically unapparent infantile thiamin deficiency in Vientiane, Laos.
Clinically unapparent infantile thiamin deficiency in Vientiane, Laos.
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DOI：
10.1371/journal.pntd.0000969
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发表时间：
2011-02-22
影响因子：
3.8
通讯作者：
Newton PN
中科院分区：
文献类型：
--
作者：
Khounnorath S;Chamberlain K;Taylor AM;Soukaloun D;Mayxay M;Lee SJ;Phengdy B;Luangxay K;Sisouk K;Soumphonphakdy B;Latsavong K;Akkhavong K;White NJ;Newton PN
脚气病发生在老挝人民民主共和国万象的母乳喂养婴儿中。临床疾病可能是亚临床硫胺素缺乏症导致其他疾病的冰山一角。硫胺素治疗可改善预后。一个队列的778名患病婴儿在一年内没有脚气病的临床证据入院进行了前瞻性研究和红细胞转酮酶测定（ETK）进行。根据活化系数（α>31%）和基础ETK活性<0.59微摩尔/分钟/gHb定义生化硫胺素缺乏症。在778名婴儿中，中位（范围）年龄为5（0-12）个月，79.2%母乳喂养，5.1% α>31%，13.4%基础ETK<0.59微摩尔/分钟/gHb。≥2月龄婴儿硫胺素缺乏症的生化标志物频率较高。死亡率为5.5%，但在≥2个月的婴儿中，基础ETK<0.59微摩尔/分钟/gHb的婴儿死亡率（3/47，6.4%）高于基础ETK≥0.59微摩尔/分钟/gHb的婴儿（1/146，0.7%）（P = 0.045，相对危险度= 9.32（95%CI 0.99 - 87.5））。 多因素回归分析表明，婴儿年龄≥2个月和母亲受教育年限较少与婴儿基础ETK<0.59微摩尔/分钟/gHb独立相关。在万象，住院的患病婴儿（2个月以上）中，临床上不明显的硫胺素缺乏症很常见。这可能会导致死亡率，可能需要为患病婴儿提供低临床阈值的硫胺素。婴儿脚气病，或婴儿临床硫胺素（维生素B1）缺乏症，是亚洲一种被遗忘的疾病，100年前它是一个主要的公共卫生问题。患有这种缺陷的婴儿，通常年龄在12 -3个月，出现心力衰竭，但如果给予硫胺素注射，通常会迅速改善。它在老挝人民民主共和国万象（老挝）仍然相对常见，可能是因为长期的产时和产后食物回避行为。临床疾病可能是冰山一角，亚临床硫胺素缺乏导致婴儿患病，而没有明显的临床脚气病。因此，我们招募了778名在万象Mahosot医院一年内入院的患病婴儿，没有脚气病的临床证据，并进行了红细胞转酮酶（ETK）测定。13.4%的婴儿基础ETK<0.59微摩尔/分钟/gHb，表明生化硫胺素缺乏。死亡率为5.5%，但在≥2个月的婴儿中，基础ETK<0.59微摩尔/分钟/gHb的婴儿死亡率（3/47，6.4%）高于基础ETK≥0.59微摩尔/分钟/gHb的婴儿（1/146，0.7%）（P = 0.045，相对危险度= 9.32（95%CI 0.99 - 87.5））。 我们的结论是，临床上不明显的硫胺素缺乏症是常见的生病的婴儿（≥2个月大）住院万象。这可能会导致死亡率，可能需要为患病婴儿提供低临床阈值的硫胺素。
Beriberi occurs in Vientiane, Lao PDR, among breastfed infants. Clinical disease may be the tip of an iceberg with subclinical thiamin deficiency contributing to other illnesses. Thiamin treatment could improve outcome. A cohort of 778 sick infants admitted during one year without clinical evidence of beriberi were studied prospectively and erythrocyte transketolase assays (ETK) performed. Biochemical thiamin deficiency was defined both in terms of the activation coefficient (α>31%) and basal ETK activity <0.59 micromoles/min/gHb. Of the 778 infants, median (range) age was 5 (0–12) months, 79.2% were breastfed, 5.1% had α>31% and 13.4 % basal ETK<0.59 micromoles/min/gHb. Infants ≥2 months old had a higher frequency of biochemical markers of thiamin deficiency. Mortality was 5.5% but, among infants ≥2 months old, mortality was higher in those with basal ETK<0.59 micromoles/min/gHb (3/47, 6.4%) than in those with basal ETK≥0.59 micromoles/min/gHb (1/146, 0.7%) (P = 0.045, relative risk = 9.32 (95%CI 0.99 to 87.5)). Multivariate regression analysis indicated that infant age ≥2 months and fewer maternal years of schooling were independently associated with infant basal ETK<0.59 micromoles/min/gHb. Clinically unapparent thiamin deficiency is common among sick infants (≥2 months old) admitted to hospital in Vientiane. This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed. Infantile beriberi, or clinical thiamin (vitamin B1) deficiency in infants, is a forgotten disease in Asia, where 100 years ago it was a major public health problem. Infants with this deficiency, commonly aged ∼ 2–3 months, present in cardiac failure but usually rapidly improve if given thiamin injections. It remains relatively common in Vientiane, Lao PDR (Laos), probably because of prolonged intra- and post-partum food avoidance behaviours. Clinical disease may be the tip of an iceberg with subclinical thiamin deficiency contributing to sickness in infants without overt clinical beriberi. We therefore recruited 778 sick infants admitted during one year at Mahosot Hospital, Vientiane, without clinical evidence of beriberi, and performed erythrocyte transketolase (ETK) assays. 13.4 % of infants had basal ETK<0.59 micromoles/min/gHb suggesting biochemical thiamin deficiency. Mortality was 5.5% but, among infants ≥2 months old, mortality was higher in those with basal ETK<0.59 micromoles/min/gHb (3/47, 6.4%) than in those with basal ETK≥0.59 micromoles/min/gHb (1/146, 0.7%) (P = 0.045, relative risk = 9.32 (95%CI 0.99 to 87.5)). We conclude that clinically unapparent thiamin deficiency is common among sick infants (≥2 months old) admitted to hospital in Vientiane. This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed.
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