TUMOR NECROSIS FACTOR AND DISEASE SEVERITY IN CHILDREN WITH FALCIPARUM-MALARIA
TUMOR NECROSIS FACTOR AND DISEASE SEVERITY IN CHILDREN WITH FALCIPARUM-MALARIA
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DOI：
10.1056/nejm198906153202404
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发表时间：
1989-06-15
影响因子：
158.5
通讯作者：
LAMBERT, PH
中科院分区：
文献类型：
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作者：
GRAU, GE;TAYLOR, TE;LAMBERT, PH
为了研究肿瘤坏死因子在恶性疟原虫感染中的作用，我们测定了65名马拉维严重恶性疟原虫疟疾患儿的血清中这种细胞因子的浓度。在这些儿童中（平均年龄5.3岁），55例无意识，10例出现低血糖。虽然有相当大的重叠，平均值（±）。SEM）的肿瘤坏死因子的初始血清浓度在10名死亡的患者中显著更高（709 . 312 pg/ml）比存活的55人（184 . ±. 32 pg/ml; P < 0.02）。死亡率随着肿瘤坏死因子浓度的增加而增加：低于100 pg/ml时，24例患者中有1例死亡; 100 - 500 pg/ml时，34例患者中有6例死亡;超过500 pg/ml时，7例患者中有3例死亡。高浓度的肿瘤坏死因子还与低血糖（P < 0.02）、高寄生虫血症（P < 0.002）、年龄小于3岁（P < 0.03）和预后指数测量的疾病严重程度（P < 0.0005）相关。入院后不久死亡的患者血清肿瘤坏死因子浓度最高。所有患者脑脊液中的浓度均在正常范围内。在从38名恢复期患者获得的血清样品中，肿瘤坏死因子的浓度下降到平均16 ± 0.5。每毫升3微克。我们的结论是，肿瘤坏死因子的水平经常增加，在严重的恶性疟疾患者，特别是在那些与脑型疟疾或低血糖。要确定它是否是重要的发病机制的体征和症状的疾病需要进一步的研究。
To investigate the role of tumor necrosis factor in Plasmodium falciparum infections, we measured serum concentrations of this cytokine in 65 Malawian children with severe falciparum malaria. Of these children (mean age, 5.3 years), 55 were unconscious and 10 had hypoglycemia at presentation. Although there was considerable overlap, the mean (.+-. SEM) initial serum concentration of tumor necrosis factor was significantly higher in the 10 patients who died (709 .+-. 312 pg per milliliter) than in the 55 who survived (184 .+-. 32 pg per milliliter; P < 0.02). The mortality rate increased with the concentration of tumor necrosis factor: at a level of less than 100 pg per milliliter, 1 of 24 patients died; at 100 to 500 pg per milliliter, 6 of 34 patients; and at more than 500 pg per milliliter, 3 of 7 patients. High concentrations of tumor necrosis factor were also associated with hypoglycemia (P < 0.02), hyperparasitemia (P < 0.002), age under three years (P < 0.03), and severity of illness as measured by a prognostic index (P < 0.0005). The highest serum concentrations of tumor necrosis factor were found in patients who died shortly after admission. The concentrations in cerebrospinal fluid were within the normal range in all patients. In serum samples obtained from 38 convalescent patients, the concentration of tumor necrosis factor declined to a mean of 16 .+-. 3 pg per milliliter. We conclude that the level of tumor necrosis factor is frequently increased in patients with severe falciparum malaria, particularly in those with cerebral malaria or hypoglycemia. To determine whether it is important in the pathogenesis of the signs and symptoms of the disease requires further study.