Clinical predictors of severe malarial anaemia in a holoendemic Plasmodium falciparum transmission area
Clinical predictors of severe malarial anaemia in a holoendemic Plasmodium falciparum transmission area
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DOI：
10.1111/j.1365-2141.2010.08147.x
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发表时间：
2010-06-01
影响因子：
6.5
通讯作者：
Perkins, Douglas J.
中科院分区：
文献类型：
--
作者：
Novelli, Enrico M.;Hittner, James B.;Perkins, Douglas J.
严重疟疾贫血（SMA）是恶性疟原虫感染的常见并发症，在全流行传播地区的儿科人群中，其死亡率可能超过30%。降低与SMA相关的发病率和死亡率的一个策略是确定临床预测因素，这些预测因素可以很容易地被护理人员识别，从而进行及时的治疗干预。为了确定SMA的临床预测因素，我们招募了在Siaya区一家农村医院出现急性疾病的肯尼亚儿童（3-36个月，n = 671）。在入组时测量人口统计学、临床、实验室和血液学参数。由于人类免疫缺陷病毒-1和菌血症促进血红蛋白（Hb）浓度降低，因此这些感染的儿童被排除在分析之外。感染单一恶性疟原虫的儿童（n = 355）被分为三组：无并发症疟疾（Hb >= 110 g/l）；非SMA （60 < Hb < 109）和SMA （Hb < 60 g/l）。SMA的特征是年龄较小，单核细胞增多，血小板减少，网状细胞增多，红细胞生成减少，含色素单核细胞（PCM）升高，呼吸窘迫，结膜和手掌苍白，脾肿大，营养不良的迹象，持续发烧和呕吐。Logistic回归分析显示，年龄、网织红细胞计数、PCM的存在、结膜和手掌苍白是SMA的显著预测因素。在生活在资源贫乏环境中的儿童中识别这些临床症状可能有助于指导SMA的识别和管理。
P>Severe malarial anaemia (SMA) is a common complication of Plasmodium falciparum infections, resulting in mortality rates that may exceed 30% in paediatric populations residing in holoendemic transmission areas. One strategy for reducing the morbidity and mortality associated with SMA is to identify clinical predictors that can be readily recognized by caregivers for prompt therapeutic interventions. To determine clinical predictors of SMA, Kenyan children (3-36 months, n = 671) presenting with acute illness at a rural hospital in Siaya District were recruited. Demographic, clinical, laboratory and haematological parameters were measured upon enrolment. As human immunodeficiency virus-1 and bacteraemia promote reduced haemoglobin (Hb) concentrations, children with these infections were excluded from the analyses. Children with P. falciparum mono-infections (n = 355) were stratified into three groups: uncomplicated malaria (Hb >= 110 g/l); non-SMA (60 < Hb < 109), and SMA (Hb < 60 g/l). SMA was characterized by a younger age, monocytosis, thrombocytopenia, reticulocytosis, reduced erythropoiesis, elevated pigment-containing monocytes (PCM), respiratory distress, conjunctival and palmar pallor, splenomegaly, signs of malnutrition, and protracted fever and emesis. Logistic regression analysis demonstrated that age, reticulocyte count, presence of PCM and conjunctival and palmar pallor were significant predictors of SMA. Recognition of these clinical signs in children residing in resource-poor settings may help to guide the identification and management of SMA.