DYNAMIC ALTERATION IN SPLENIC FUNCTION DURING ACUTE FALCIPARUM-MALARIA
DYNAMIC ALTERATION IN SPLENIC FUNCTION DURING ACUTE FALCIPARUM-MALARIA
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DOI：
10.1056/nejm198709103171105
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发表时间：
1987-09-10
影响因子：
158.5
通讯作者：
WYLER, DJ
中科院分区：
文献类型：
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作者：
LOOAREESUWAN, S;HO, M;WYLER, DJ
感染了疟原虫的红细胞失去了正常的变形能力，对脾滤过变得敏感。在动物模型中，这是抗疟疾防御的一种机制。为探讨急性恶性疟疾对脾滤过功能的影响，我们测定了25例急性恶性疟疾患者和10例正常对照受热~(51)Cr标记自体红细胞的清除率。可以区分两组患者。16例患者脾肿大，标记红细胞清除明显加快(清除半衰期，8.4.+-。4.4分钟[平均+-]SD]与62.5.+-。对照组36.5min，P<；0.001)，红细胞压积低于无脾肿大组(P<；0.001)。在9例无脾肿大的患者中，清除正常。然而，在实施抗疟疾化疗后，这组患者的清除速度加快到与脾肿大患者相似的超常率，但没有发生可检测到的脾肿大。在脾肿大组，治疗后清除率没有明显改变。6周后，两组中的大多数患者都恢复了正常的清扫率。我们的结论是，在疟疾患者中，如果有脾肿大，标记红细胞的脾清除能力会增强，只有在治疗后，如果没有脾肿大，才会增强。这种增强的脾功能是否适用于疟疾患者中被寄生虫感染的红细胞，是否具有任何临床益处，还有待进一步研究。
Plasmodium-infected erythrocytes lose their normal deformability and become susceptible to splenic filtration. In animal models, this is one mechanism of antimalarial defense. To assess the effect of acute falciparum malaria on splenic filtration, we measured the clearance of heated 51Cr-labeled autologous erythrocytes in 25 patients with acute falciparum malaria, and in 10 uninfected controls. Two groups of patients could be distinguished. Sixteen patients had splenomegaly, markedly accelerated clearance of the labeled erythrocytes (clearance half-time, 8.4 .+-. 4.4 minutes [mean .+-. SD] vs. 62.5 .+-. 36.5 minutes in controls; P < 0.001), and a lower mean hematocrit than did the patients without splenomegaly (P < 0.001). In the nine patients without splenomegaly, clearance was normal. After institution of antimalarial chemotherapy, however, the clearance in this group accelerated to supernormal rates similar to those in the patients with splenomegaly, but without the development of detectable splenomegaly. Clearance was not significantly altered by treatment in the group with splenomegaly. Six weeks later, normal clearance rates were reestablished in most patients in both groups. We conclude that splenic clearance of labeled erythrocytes is enhanced in patients with malaria if splenomegaly is present and is enhanced only after treatment if splenomegaly is absent. Whether this enhanced splenic function applies to parasite-infected erythrocytes in patients with malaria and has any clinical benefit will require further studies.