Perfusion Abnormalities in Children with Cerebral Malaria and Malarial Retinopathy
Perfusion Abnormalities in Children with Cerebral Malaria and Malarial Retinopathy
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DOI：
10.1086/595735
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发表时间：
2009-01-15
影响因子：
6.4
通讯作者：
Molyneux, Malcolm E.
中科院分区：
文献类型：
--
作者：
Beare, Nicholas A. V.;Harding, Simon P.;Molyneux, Malcolm E.
背景资料。在脑型疟疾(CM)患者中，视网膜血管造影术可以在体内研究感染的中枢神经系统微血管。我们的目的是用荧光素血管造影术检查CM患儿的视网膜血流，以探讨CM的病理生理机制。我们对马拉维伊丽莎白女王中心医院的CM患儿进行了荧光素血管造影术。我们将血管造影术与眼底镜检查结果联系起来。34例CM患者进行了荧光素血管造影，其中28例(82%)发现血流灌注受损。26例(76%)可见毛细血管无灌注区。CNP的多发、散在区域是典型的，在地形图上与视网膜白化一致。9例(26%)合并缺血的患者视网膜血管较大。这些血管在眼底镜下呈白色。血管内异常9例(26%)，包括充盈缺陷和血柱斑点。15例患者(44%)发生有限的荧光素渗漏，与血管造影血管内异常或可见血管变色无关。大多数CM儿童的视网膜微血管系统都存在灌注性损伤。这证明缺氧和缺血是CM发病机制中的重要组成部分。血管闭塞和充盈缺陷很可能是由于感染的红细胞被隔离所致。改善血流灌注或限制缺氧性损伤的干预措施可能对CM有利。
Background. In patients with cerebral malaria (CM), retinal angiography allows the study of infected central nervous system microvasculature in vivo. We aimed to examine retinal perfusion in children with CM by use of fluorescein angiography to investigate the pathophysiology of CM.Methods. We performed fluorescein angiography on children with CM admitted to Queen Elizabeth Central Hospital, Malawi. We related angiograms to funduscopic findings.Results. Fluorescein angiography was performed for 34 patients with CM, and impaired perfusion was identified in 28 (82%). Areas of capillary nonperfusion (CNP) were seen in 26 patients (76%). Multiple, scattered areas of CNP were typical and topographically matched to retinal whitening. Larger retinal vessels were occluded in 9 patients (26%) who had associated ischemia. These vessels appeared white on ophthalmoscopy. Intravascular abnormalities were seen in 9 patients (26%), including filling defects and mottling of the blood column. Limited fluorescein leakage occurred in 15 patients (44%) and was not related to angiographic intravascular abnormalities or visible vessel discoloration.Conclusions. Impaired perfusion occurs in the retinal microvasculature of most children with CM. This is evidence for hypoxia and ischemia as important components in the pathogenesis of CM. Vessel occlusion and filling defects are likely to be due to sequestration of infected erythrocytes. Interventions which improve perfusion or limit hypoxic injury may be beneficial in CM.