SEVERE HYPOGLYCEMIA AND HYPERINSULINEMIA IN FALCIPARUM-MALARIA
SEVERE HYPOGLYCEMIA AND HYPERINSULINEMIA IN FALCIPARUM-MALARIA
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DOI：
10.1056/nejm198307143090201
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
TURNER, RC
中科院分区：
文献类型：
--
作者：
WHITE, NJ;WARRELL, DA;TURNER, RC
在泰国东部研究了恶性疟患者低血糖的发生、临床表现和机制。17名患者发生了低血糖，通常是严重和复发的，其中包括151名脑型疟疾患者中的12名。研究了Epilepsy（30例）。恶性疟患者血浆胰岛素和C肽浓度过高，乳酸和丙氨酸浓度明显高于血糖正常者（P < 0.05）。患者（16例）接受了奎宁治疗;低血糖时血浆奎宁和胰岛素浓度相关（P = 0.007）。在7名健康的空腹志愿者中，静脉注射奎宁增加了平均血浆胰岛素浓度（± 0.001）。SD）从8.9 .+-。3.1至17.1 .+-。8.4 mU/l（P = 0.02），并将平均血浆葡萄糖浓度从88 ± 0.001 μ g/ml降低至100 ± 0.001 μ g/ml。20到68 .+-. 23/dl（P = 0.002）。在恶性疟原虫中，奎宁诱导的胰岛素分泌可能会导致低血糖，但其他因素，包括疟原虫对葡萄糖的大量需求也可能起作用。这种重要的并发症与怀孕和严重疾病有关，必须排除所有意识受损或恶化的恶性疟疾患者。
The occurrence, clinical manifestations, and mechanism of hypoglycemia in patients with falciparum malaria [Plasmodium falciparum] were studied in eastern Thailand. Hypoglycemia, which was often severe and recurrent, occurred in 17 patients, including 12 in a series of 151 patients with cerebral malaria. Episodes (30) were investigated. Plasma concentrations of insulin and C peptide were inappropriately high, and lactate and alanine concentrations were significantly higher than in patients with falciparum malaria who were normoglycemic (P < 0.05). Patients (16) had received quinine; plasma quinine and insulin concentrations were correlated at the time of hypoglycemia (P = 0.007). In 7 healthy fasting volunteers i.v. quinine increased the mean plasma insulin concentration (.+-. SD) from 8.9 .+-. 3.1 to 17.1 .+-. 8.4 mU/l (P = 0.02) and reduced the mean plasma glucose concentration from 88 .+-. 20 to 68 .+-. 23/dl (P = 0.002). In falciparum malaria quinine-induced insulin secretion may precipitate hypoglycemia, but other factors, including the large glucose requirements of the malaria parasites may also contribute. This important complication, associated with pregnancy and severe disease, must be excluded in all patients with falciparum malaria who have impaired or deteriorating consciousness.