ERYTHROCYTE SEQUESTRATION AND ANEMIA IN SEVERE FALCIPARUM-MALARIA - ANALYSIS OF ACUTE CHANGES IN VENOUS HEMATOCRIT USING A SIMPLE MATHEMATICAL-MODEL
ERYTHROCYTE SEQUESTRATION AND ANEMIA IN SEVERE FALCIPARUM-MALARIA - ANALYSIS OF ACUTE CHANGES IN VENOUS HEMATOCRIT USING A SIMPLE MATHEMATICAL-MODEL
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DOI：
10.1172/jci114776
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发表时间：
1990-09-01
影响因子：
15.9
通讯作者：
WHITE, NJ
中科院分区：
文献类型：
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作者：
DAVIS, TME;KRISHNA, S;WHITE, NJ
应用数学模型对46例严重感染的恶性疟疾患者的微血管红细胞隔离进行了评价。从入院时的放射性同位素循环红细胞体积和静脉血细胞比容来看，模型来源的序贯红细胞压积(平均[95%可信限]：0.70[0.43~0.97]，n=29)是外周血的两倍(0.33[0.30~0.36])。连续的网织红细胞和放射性标记的红细胞计数表明，在最初的治疗过程中，少量细胞进入循环。26例未输血患者的红细胞压积平均下降超过84h，符合三项方程。一级下降(T1/2 2.0h[0.6-3.4])表明，通过复水平均可使血浆体积膨胀7.5%。零级下降6.3%(3.1-9.5)(T1/2 25.7小时[21.1-30.2])，同时平均寄生虫血症从4.5%(3.6-5.4)下降；根据这些数据，模型得出的平均隔离红细胞体积(入院红细胞压积的4.8%)与外周寄生虫负担相似。第二次，一级下降(T1/21,047小时[278-1,816])表明未感染的红细胞丢失，平均寿命为62天。在初始治疗期间预测的总血浆容量膨胀(21.2%)与11名患者的放射性同位素估计值(17.3%[2.0-33.1])相似。将该模型应用于单个患者的数据显示，循环和隔离的寄生细胞的相对比例存在很大差异。该模型提供了疟疾中所有寄生红细胞的性质和命运的证据。
Microvascular erythrocyte sequestration, the characteristic pathological feature of falciparum malaria, was evaluated using a mathematical model in 46 patients with severe infections. From admission radioisotopic circulating red cell volumes and simultaneous venous hematocrits, the model-derived seqestrum hematocrit (mean [95% confidence limits]: 0.70 [0.43-0.97], n = 29) was twice that of peripheral blood (0.33 [0.30-0.36]). Serial reticulocyte and radiolabeled erythrocyte counts indicated that small numbers of cells enter the circulation during initial therapy. The mean fall in hematocrit over 84 h in 26 nontransfused patients conformed to a three-term equation. A first-order decline (t1/2 2.0 h [0.6-3.4]) suggested an average 7.5% plasma volume expansion through rehydration. A zero-order 6.3% (3.1-9.5) fall (t1/2 25.7 h [21.1-30.2]) occurred contemporaneously with a fall in mean parasitemia from 4.5% (3.6-5.4); from these data the model-derived average sequestered erythrocyte volume (4.8% of the admission hematocrit) was similar to the peripheral parasite burden. A second, first-order fall (t1/2 1,047 h [278-1,816]) indicated loss of uninfected erythrocytes with mean lifespan 62 d. Predicted total plasma volume expansion during initial therapy (21.2%) was similar to radioisotopic estimates in 11 patients (17.3% [2.0-33.1]). Application of the model to individual patient data showed wide variations in relative proportions of circulating and sequestered parasitized cells. The model provides evidence of the nature and fate of all parasitized erythrocytes in malaria.