METHEMOGLOBINEMIA PROVOKED BY MALARIAL CHEMOPROPHYLAXIS IN VIETNAM
METHEMOGLOBINEMIA PROVOKED BY MALARIAL CHEMOPROPHYLAXIS IN VIETNAM
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DOI：
10.1056/nejm196811212792102
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发表时间：
1968-01-01
影响因子：
158.5
通讯作者：
CONRAD, ME
中科院分区：
文献类型：
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作者：
COHEN, RJ;SACHS, JR;CONRAD, ME
六名美国士兵因服用抗疟药物出现发绀症状而从越南撤离。对这些受试者和另外两名受试者的研究表明，红细胞中 NADH 高铁血红蛋白还原酶的浓度显着降低，并且红细胞在体外将高铁血红蛋白还原为血红蛋白的能力降低。其中两名受试者是同卵双胞胎；对其 19 名家庭成员进行的一项研究显示，另外 3 名成员缺乏酶，另外 10 名亲属的酶值也较低。氯喹、伯氨喹和二氨基二苯砜均被证明会在酶缺乏的受试者中引起高铁血红蛋白血症，其剂量对正常人没有影响。抗疟药物产生的紫绀使得临床能够识别出通常未被检测到的红细胞酶缺陷。缺乏 NADH 高铁血红蛋白还原酶的杂合子可能比我们意识到的要多，越南抗疟药物的持续使用可能会提供有关这种缺陷的真实流行情况的新信息。
Six American soldiers were evacuated from Vietnam because they became cyanotic while taking antimalarial drugs. Investigations of these and two additional subjects revealed a markedly decreased concentration of NADH methemoglobin reductase in red blood cells and a decreased capacity of erythrocytes to reduce methemoglobin to hemoglobin in vitro. Two of the subjects were identical twins; a study of 19 members of their family revealed three additional enzyme-deficient members and 10 additional relatives with low enzyme values. Chloroquine, primaquine and diaminodiphenylsulfone were each shown to provoke methemoglobinemia in enzyme-deficient subjects in doses that have no effect on normal persons. The cyanosis produced by antimalarial drugs permitted clinical recognition of a usually undetected enzymatic defect of the erythrocyte. Heterozygotes with a deficiency of NADH methemoglobin reductase may be more numerous than has been realized, and the continued use of antimalarial drugs in Vietnam may provide new information about the true prevalence of this defect.