Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis.
Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis.
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血红蛋白病和疟疾的临床流行病学：系统评价和荟萃分析。
DOI：
10.1016/s1473-3099(12)70055-5
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发表时间：
2012-06
影响因子：
56.3
通讯作者：
Fairhurst, Rick M.
中科院分区：
文献类型：
--
作者：
Taylor, Steve M.;Parobek, Christian M.;Fairhurst, Rick M.
血红蛋白病可不同程度地降低患疟疾综合征的风险。量化这些关系可能会加强疟疾发病机制和免疫的转化研究的基础。检索MEDLINE和Embase数据库（1950年至2011年9月9日），以确定估计血红蛋白病患者和非血红蛋白病患者疟疾风险的研究。从参考文献列表中确定了其他研究。包括恶性疟原虫相关的严重疟疾、无并发症疟疾、无症状寄生虫血症或妊娠相关疟疾和间日疟原虫疟疾的结局。两名独立的评审员确定研究，评估其质量，并提取数据;当结果报告在一个以上的研究时，数据进行荟萃分析。在识别的62项研究中，44项报告了HbAS，19项报告了HbAC和HbCC，18项报告了α-地中海贫血。病例对照研究表明，HbAS的严重疟疾风险降低（总结比值比[OR] 0.09; 95%置信区间[CI] 0.06 - 0.12），HbCC（总结OR 0.27; 95% CI 0.11 - 0.63），纯合子α-地中海贫血（总结OR 0.63; 95% CI 0.48 - 0.83）、HbAC（总结OR 0.83; 95% CI 0.74 - 0.92）和杂合型α-地中海贫血（总结OR 0.83; 95% CI 0.74 - 0.92）。只有HbAS始终与预防单纯性疟疾相关（汇总发病率比0.69; 95% CI 0.61 - 0.79）;无症状寄生虫血症无保护作用。关于β地中海贫血、HbE、间日疟原虫疟疾和妊娠相关疟疾的临床研究很少。对HbAS、HbCC、HbAC以及纯合子和杂合子α-地中海贫血的保护作用对严重疟疾综合征具有重要意义，但这些血红蛋白病的保护程度差异很大。对无并发症疟疾和无症状寄生虫病的保护是轻微的或不存在的。通过减轻疟疾的严重程度，血红蛋白病可作为研究疟疾发病机制和免疫机制的模型。
Haemoglobinopathies variously reduce the risk of developing malaria syndromes. Quantifying these relationships may strengthen the foundation for translational studies of malaria pathogenesis and immunity. The databases of MEDLINE and Embase (1950 – September 9, 2011) were searched to identify studies that estimated the risk of malaria in patients with and without haemoglobinopathies. Additional studies were identified from reference lists. Included outcomes were Plasmodium falciparum-related outcomes of severe malaria, uncomplicated malaria, asymptomatic parasitaemia, or pregnancy-associated malaria, and P. vivax malaria. Two independent reviewers identified studies, assessed their quality, and extracted data; data were meta-analyzed when outcomes were reported in more than one study. Of 62 identified studies, 44 reported on HbAS, 19 on HbAC and HbCC, and 18 on α-thalassaemia. Case-control studies showed a decreased risk of severe malaria for HbAS (summary Odds Ratio [OR] 0.09; 95% confidence interval [CI] 0.06 – 0.12), HbCC (summary OR 0.27; 95% CI 0.11 – 0.63), homozygous α-thalassaemia (summary OR 0.63; 95% CI 0.48 – 0.83), HbAC (summary OR 0.83; 95% CI 0.74 – 0.92), and heterozygous α-thalassaemia (summary OR 0.83; 95% CI 0.74 – 0.92). Only HbAS was consistently associated with protection from uncomplicated malaria (summary Incidence Rate Ratio 0.69; 95% CI 0.61 – 0.79); none demonstrated protection from asymptomatic parasitaemia. There was a paucity of clinical studies investigating β-thalassaemia, HbE, P. vivax malaria, and pregnancy-associated malaria. Protection from severe malaria syndromes is significant for HbAS, HbCC, HbAC, and homozygous and heterozygous α-thalassaemia, but these haemoglobinopathies differ substantially in the degrees of protection. Protection from uncomplicated malaria and asymptomatic parasitaemia is mild or absent. By attenuating the severity of malaria, haemoglobinopathies serve as a model for investigating the mechanisms of malaria pathogenesis and immunity.