摘要
目的了解临床医师使用复方青蒿素(ACTs)治疗缅甸输入恶性疟疗效。方法在缅甸输入性恶性疟较多的云南省保山市,对2014—2015年收治恶性疟病人诊断、感染来源、输入性疟疾的判定、治疗情况等进行调查,对治疗失败患者开展疟原虫青蒿素抗性基因检测、分析。结果 2014—2015年保山市全市共收治疗恶性疟病人42例,其中37例得到标准疗程的双氢青蒿素哌喹片治疗,治疗规范率88.1%;5例治疗不规范,不规范率11.9%。规范治疗的37例中,治愈34例,治愈率91.9%;治疗失败3例,治疗失败率为8.1%。该3例均为缅甸输入病例,其中2例在缅甸韦茂感染,1例感染地不详;对其中保存血液样本的2例治疗失败病例检测恶性疟原虫青蒿素抗性基因(K13)结果显示,疟原虫K13基因F446I位点均发生突变。结论双氢青蒿素哌喹片对缅甸输入的恶性疟疗效较好,该药仍然可以作为治疗恶性疟的一线药物;发现2例治疗失败病例,且疟原虫K13基因F446I位点发生突变。
Objective To evaluate the therapeutic efficacy of Dihydroartemisinin-piperaquine （DHA-PIP） on the treatment of imported falciparum malaria from Burma. Methods Investigation was carried out in Baoshan of Yunnan Province from 2014 to 2015, which had high incidence of imported malaria from Burma. A standardized questionnaire was completed with each patient in the study. Data were collected on diagnosis of malaria patients, the source of infection , the judgement of imported malaria and the treatment, meanwhile, detection and analysis the mutations in a P. falciparum gene encoding a kelch protein on chromosome 13（13K） for failed treatment cases. Results The 42 patients were treated with DHA-PIP, of which 37 patients got with standardized treatment, the standard rate was 88.1% , and 5 cases were not with standardized treatment, the rate was 11.9%. 34 of the patients were adequate clinical and parasitological response （ACPR）, the ACPR rate was 91.9%. All of the 3（8.1%） failed patients were imported from Burma, of which two patients were in Mengmao City of Burma and the other one was unidentified. Two blood samples of the failed treatment were detected with mutations in a P.falciparum gene encoding a kelch protein on chromosome 13（13K） and a single mutation of F446I were observed in two samples. Conclusion In terms of efficacy, DHA-PIP is still effective for imported falciparum malaria from Burma, it can be used as a first-line medicine for the treatment of falciparum malaria; and a single mutation of F446I were observed in two failed treatment patients.
作者
杨恒林
汤林华
刘慧
李美
YANG Henglin;TANG Linhua;LIU Hui;LI Mei(Yunnan Institute of Parasitic Diseases,Yunnan Provincial Center of Malaria Research,Pu＇er,Yunnan 665000,China)
出处
《中国热带医学》
CAS
2018年第7期646-649,共4页
China Tropical Medicine
基金
世界卫生组织/湄公河项目基金(No. WP/08/MVP/00512
No. WP/09/MVP/004782
No. CHN-12- MVP/001)
关键词
疟疾
输入性恶性疟
抗疟药
双氢青蒿素哌喹
疗效
falciparum malaria
imported case
anti-malaria
Dihydroartemisinin-piperaquine
efficacy
