Re-Visiting Trichuris trichiura Intensity Thresholds Based on Anemia during Pregnancy
Re-Visiting Trichuris trichiura Intensity Thresholds Based on Anemia during Pregnancy
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DOI：
10.1371/journal.pntd.0001783
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发表时间：
2012-09-01
影响因子：
3.8
通讯作者：
Montresor, Antonio
中科院分区：
文献类型：
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作者：
Gyorkos, Theresa W.;Gilbert, Nicolas L.;Montresor, Antonio
背景：目前用于鞭虫的强度类别或阈值(即。EPG强度为1-999(轻)；1,000-9999 EPG(中等)，和>；=10,000 EPG(重)是在20世纪80年代开发的，当时几乎没有关于剂量-反应关系的流行病学数据。这项研究旨在确定孕妇毛滴虫相关性贫血的阈值，并描述这一阈值在初级预防和化疗干预必要性方面的意义。方法/主要研究结果：在秘鲁伊基托斯，935名孕妇在怀孕中期进行了毛滴虫感染检测；在整个怀孕期间每天补充铁剂；并在怀孕后期测量了她们的血液血红蛋白水平。旋毛虫强度最高的两个五分位数(601-1632EPG和>；=1633EPG)的女性的平均血红蛋白浓度显著低于最低的五分位数(0-24EPG)。他们患贫血的风险也有统计学意义上的显著提高，调整后的优势比分别为1.67(95%可信区间：1.02，2.62)和1.73(95%可信区间：1.09，2.74)。结论/意义：这一分析支持将毛滴虫感染&>1,000 EPG归类为目前世界卫生组织定义的“中度”。由于这种中等水平的旋毛虫感染被发现是孕妇贫血的一个重要风险因素，因此被认为导致或加剧贫血的旋毛虫感染强度不应再局限于“重度”强度类别。现在应该包括“重度”和“中等”强度的鞭虫感染。针对孕妇或贫血令人担忧的人群的循证驱虫战略应相应更新。
Background: The intensity categories, or thresholds, currently used for Trichuris trichiura (ie. epg intensities of 1-999 (light); 1,000-9,999 epg (moderate), and >= 10,000 epg (heavy)) were developed in the 1980s, when there were little epidemiological data available on dose-response relationships. This study was undertaken to determine a threshold for T. trichiura-associated anemia in pregnant women and to describe the implications of this threshold in terms of the need for primary prevention and chemotherapeutic interventions.Methodology/Principal Findings: In Iquitos, Peru, 935 pregnant women were tested for T. trichiura infection in their second trimester of pregnancy; were given daily iron supplements throughout their pregnancy; and had their blood hemoglobin levels measured in their third trimester of pregnancy. Women in the highest two T. trichiura intensity quintiles (601-1632 epg and >= 1633 epg) had significantly lower mean hemoglobin concentrations than the lowest quintile (0-24 epg). They also had a statistically significantly higher risk of anemia, with adjusted odds ratios of 1.67 (95% CI: 1.02, 2.62) and 1.73 (95% CI: 1.09, 2.74), respectively.Conclusions/Significance: This analysis provides support for categorizing a T. trichiura infection >= 1,000 epg as 'moderate', as currently defined by the World Health Organization. Because this 'moderate' level of T. trichiura infection was found to be a significant risk factor for anemia in pregnant women, the intensity of Trichuris infection deemed to cause or aggravate anemia should no longer be restricted to the 'heavy' intensity category. It should now include both 'heavy' and 'moderate' intensities of Trichuris infection. Evidence-based deworming strategies targeting pregnant women or populations where anemia is of concern should be updated accordingly.