Demonstration of anti-disease immunity to Plasmodium vivax malaria in Sri Lanka using a quantitative method to assess clinical disease
Demonstration of anti-disease immunity to Plasmodium vivax malaria in Sri Lanka using a quantitative method to assess clinical disease
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DOI：
10.4269/ajtmh.1998.58.204
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发表时间：
1998-02-01
影响因子：
3.3
通讯作者：
Mendis, KN
中科院分区：
文献类型：
--
作者：
Karunaweera, ND;Carter, R;Mendis, KN
通过量化症状的强度以及测量病理学的几个血液学指标来研究对疟疾的临床免疫（红细胞沉降率[ESR]、血清胆红素、网织红细胞计数、血浆肿瘤坏死因子-α [TNF-α]和血糖水平），并在43名非免疫患者中进行比较，这些患者是该国非疟疾流行地区的居民。使用问卷对所有患者的11种症状的强度进行数字评分。该临床评分通过将内部对照引入问卷并将其与基础病理学相关联来验证。无论是临床疾病的强度，以及潜在的病理学程度被发现是显着较低的流行区患者（平均临床评分= 8.8，中位数ESR = 8毫米）与非流行区患者（平均临床评分= 19.0，中位数ESR 31.5毫米）。疫区病人的寄生虫密度（平均0.06%）也低于非疫区病人（平均0.12%）（P < 0.05）。而在任何寄生虫密度下，流行区患者的临床疾病和病理均显著低于对照组（P < 0.001），表明流行区患者的临床免疫是对寄生虫的真正耐受。尽管两组患者的血浆TNF-α水平均升高，但非流行区患者的水平显著高于流行区患者（P < 0.01），在血浆TNF-α水平相当的情况下，非流行区患者的临床疾病和潜在病理学程度均高于流行区患者，提示如果TNF-α确实是临床疾病的介质，则流行区患者可能对其作用具有耐受性。在这些间日疟原虫患者中没有观察到低血糖，尽管一些患者血浆TNF-α水平较高。
Clinical immunity to malaria was studied by quantifying the intensity of symptoms as well as by measurement of several hematologic indicators of pathology (the erythrocyte sedimentation rate [ESR], serum bili-rubin, reticulocyte count, plasma tumor necrosis factor-alpha [TNF-alpha], and blood glucose levels) in 39 Plasmodium vivax malaria patients exposed to endemic malaria in southern Sri Lanka, and for comparison in 43 nonimmune patients who were residents of nonmalarious regions of the country. The intensity of 11 symptoms was scored numerically in all patients using a questionnaire. This clinical score was validated by introducing internal controls to the questionnaire, and by correlating it with the underlying pathology. Both the intensity of clinical disease as well as the degree of underlying pathology were found to be significantly lower in endemic area patients (mean clinical score = 8.8, median ESR = 8 mm) compared with the nonendemic area patients (mean clinical score = 19.0, median ESR 31.5 mm). Endemic area patients also had lower parasite densities (mean = 0.06%) than those from the nonendemic area (0.12%) (P < 0.05). However, at any parasite density, both clinical disease and pathology were significantly less in the endemic area patients (P < 0.001, for both clinical score and ESR), indicating that the clinical immunity seen in the endemic area patients was a true tolerance of parasites. Although plasma TNF-alpha levels were elevated in both groups of patients, they were significantly higher in the nonendemic area patients than in patients from the endemic area (P < 0.01), Furthermore, at comparable levels of plasma TNF-alpha, nonendemic area patients had both a higher intensity of clinical disease and an underlying pathology than those from the endemic area, suggesting that if TNF-alpha is indeed a mediator of clinical disease, the endemic area patients may be tolerant to its effects. Hypoglycemia was not observed in any of these P. vivax patients despite some with high levels of plasma TNF-alpha.