The challenges of introducing routine G6PD testing into radical cure: a workshop report.
The challenges of introducing routine G6PD testing into radical cure: a workshop report.
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DOI：
10.1186/s12936-015-0896-8
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发表时间：
2015-09-29
期刊：
影响因子：
3
通讯作者：
Domingo GJ
中科院分区：
文献类型：
--
作者：
Ley B;Luter N;Espino FE;Devine A;Kalnoky M;Lubell Y;Thriemer K;Baird JK;Poirot E;Conan N;Kheong CC;Dysoley L;Khan WA;Dion-Berboso AG;Bancone G;Hwang J;Kumar R;Price RN;von Seidlein L;Domingo GJ
伯氨喹是目前唯一能有效清除人类宿主体内疟疾催眠虫的药物。葡萄糖-6-磷酸脱氢酶（G6 PD）缺乏个体的溶血性副作用阻碍了8-氨基喹啉的使用。最近，已经开发了许多定性和定量快速诊断测试（RDT）形式，其提供了当前标准G6 PD活性测定的替代方案。世界卫生组织最近建议尽可能在伯氨喹根治之前对G6 PD状态进行常规检测。2015年初在菲律宾举办了一个研讨会，讨论阻碍常规G6 PD检测引入的主要挑战和知识差距。目前有两种用于测量G6 PD活性的即时（point-of-care）测试形式：与疟疾RDT相当的定性测试以及提供定量阅读的生物传感器。定性G6 PD荧光检测提供了一个二项式测试结果，易于使用，一些产品在价格上与广泛使用的荧光斑点测试相当。定性检测结果可以准确地分类半合子男性，杂合子女性，但可能会错误分类女性与中间G6 PD活性。生物传感器提供了更复杂的定量读数，更适合于识别杂合子女性。虽然与每个样品的较高成本相关，但测试的生物传感器具有在G6 PD活性的知识也相关的其他情况下更广泛使用的潜力。常规G6 PD检测的引入与常规治疗之外的额外费用相关，这些费用因环境而异，并且需要在检测引入之前进行评估。可靠的G6 PD检测有可能在未来的疟疾消除计划中发挥重要作用，但需要更好地了解如何将常规G6 PD检测最好地整合到不同的卫生环境中。本文的在线版本（doi：10.1186/s12936-015-0896-8）包含补充材料，可供授权用户使用。
The only currently available drug that effectively removes malaria hypnozoites from the human host is primaquine. The use of 8-aminoquinolines is hampered by haemolytic side effects in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. Recently a number of qualitative and a quantitative rapid diagnostic test (RDT) format have been developed that provide an alternative to the current standard G6PD activity assays. The WHO has recently recommended routine testing of G6PD status prior to primaquine radical cure whenever possible. A workshop was held in the Philippines in early 2015 to discuss key challenges and knowledge gaps that hinder the introduction of routine G6PD testing. Two point-of-care (PoC) test formats for the measurement of G6PD activity are currently available: qualitative tests comparable to malaria RDT as well as biosensors that provide a quantitative reading. Qualitative G6PD PoC tests provide a binomial test result, are easy to use and some products are comparable in price to the widely used fluorescent spot test. Qualitative test results can accurately classify hemizygous males, heterozygous females, but may misclassify females with intermediate G6PD activity. Biosensors provide a more complex quantitative readout and are better suited to identify heterozygous females. While associated with higher costs per sample tested biosensors have the potential for broader use in other scenarios where knowledge of G6PD activity is relevant as well. The introduction of routine G6PD testing is associated with additional costs on top of routine treatment that will vary by setting and will need to be assessed prior to test introduction. Reliable G6PD PoC tests have the potential to play an essential role in future malaria elimination programmes, however require an improved understanding on how to best integrate routine G6PD testing into different health settings. The online version of this article (doi:10.1186/s12936-015-0896-8) contains supplementary material, which is available to authorized users.