Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria.
Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria.
复制标题
DOI：
10.1186/1475-2875-13-91
复制
发表时间：
2014-03-12
期刊：
影响因子：
3
通讯作者：
Schultz MJ
中科院分区：
文献类型：
--
作者：
Plewes K;Royakkers AA;Hanson J;Hasan MM;Alam S;Ghose A;Maude RJ;Stassen PM;Charunwatthana P;Lee SJ;Turner GD;Dondorp AM;Schultz MJ
急性肾损伤（阿基）并发严重恶性疟原虫疟疾发生在高达40%的成年患者。在没有肾脏替代治疗（RRT）的情况下，病死率达到75%。恶性疟疾中阿基的确切病理生理学仍不清楚。组织学显示急性肾小管坏死，微血管中存在宿主单核细胞和寄生红细胞。本研究探讨了血浆可溶性尿激酶型纤溶酶原激活物受体（suPAR）（作为单核细胞活化的代理指标）和血浆恶性疟原虫富组氨酸蛋白2（PfHRP 2）（作为隔离寄生虫负荷的指标）与重症疟疾患者阿基的关系。入院血浆suPAR和PfHRP 2浓度进行了评估，在孟加拉国成人严重恶性疟疾（n = 137）。根据基于入院肌酐清除率的阿基严重程度对患者进行分层。共有106例（77%）患者发生阿基;分别有32例（23%）、42例（31%）和32例（23%）患者被分为“轻度”、“中度”和“重度”阿基组。血浆suPAR和PfHRP 2浓度随阿基严重程度而增加（趋势检验P <0.0001），并与其他肾功能不全标志物相关。入院时血浆suPAR和PfHRP 2浓度在后来需要RRT的患者中更高（分别为P <0.0001和P = 0.0004）。在多变量分析中，suPAR和PfHRP 2的增加均与尿中性粒细胞明胶酶相关脂质运载蛋白浓度增加（急性肾小管坏死的标志物）独立相关（分别为β = 16.54（95%CI 6.36-26.71）和β = 0.07（0.02-0.11））。隔离的寄生虫负荷和免疫激活都有助于严重恶性疟疾中阿基的发病机制。
Acute kidney injury (AKI) complicating severe Plasmodium falciparum malaria occurs in up to 40% of adult patients. The case fatality rate reaches 75% in the absence of renal replacement therapy (RRT). The precise pathophysiology of AKI in falciparum malaria remains unclear. Histopathology shows acute tubular necrosis with localization of host monocytes and parasitized red blood cells in the microvasculature. This study explored the relationship of plasma soluble urokinase-type plasminogen activator receptor (suPAR), as a proxy-measure of mononuclear cell activation, and plasma P. falciparum histidine rich protein 2 (PfHRP2), as a measure of sequestered parasite burden, with AKI in severe malaria. Admission plasma suPAR and PfHRP2 concentrations were assessed in Bangladeshi adults with severe falciparum malaria (n = 137). Patients were stratified according to AKI severity based on admission creatinine clearance. A total of 106 (77%) patients had AKI; 32 (23%), 42 (31%) and 32 (23%) were classified into ‘mild, ‘moderate’ and ‘severe’ AKI groups, respectively. Plasma suPAR and PfHRP2 concentrations increased with AKI severity (test-for-trend P <0.0001) and correlated with other markers of renal dysfunction. Admission plasma suPAR and PfHRP2 concentrations were higher in patients who later required RRT (P <0.0001 and P = 0.0004, respectively). In a multivariate analysis, both increasing suPAR and PfHRP2 were independently associated with increasing urine neutrophil gelatinase-associated lipocalin concentration, a marker of acute tubular necrosis (β = 16.54 (95% CI 6.36-26.71) and β = 0.07 (0.02-0.11), respectively). Both sequestered parasite burden and immune activation contribute to the pathogenesis of AKI in severe falciparum malaria.
登录
查看更多内容
影响因子：
3.3
作者：
Nguansangiam, Sudarat;Day, Nicholas P. J.;Pongponratn, Emsri
通讯作者：
Pongponratn, Emsri
影响因子：
3.5
作者：
Mustjoki, S;Sidenius, N;Vaheri, A
通讯作者：
Vaheri, A
影响因子：
6.4
作者：
Maude, Richard J.;Silamut, Kamolrat;Dondorp, Arjen M.
通讯作者：
Dondorp, Arjen M.
影响因子：
8.8
作者：
Day, NPJ;Phu, NH;White, NJ
通讯作者：
White, NJ
影响因子：
3.7
作者：
Rubach, Matthew P.;Mukemba, Jackson;Mwaikambo, Esther D.
通讯作者：
Mwaikambo, Esther D.