缅甸北部三热病人的三日疟诊断与治疗分析

发布时间：2018-06-06 16:55

本文选题：缅甸 + 三热病人　；参考：《中国病原生物学杂志》2016年08期

【摘要】：目的探讨与中国接壤的缅甸北部地区三日疟的诊断和青蒿素治疗效果,为中缅边境地区的三日疟防治提供依据。方法选择缅甸北部克钦邦三热病人进行血涂片镜检和疟原虫基因检测,对PCR扩增产物测序并进行序列比对和同源性分析;对确诊的三日疟现症患者给予青蒿琥酯片(每片含青蒿琥酯50g)治疗,总剂量16mg/kg体重,每天顿服2mg/kg体重,连服7d,首剂加倍,采用WHO推荐的28d体内法评价其疗效;建立EXCEL2007数据库,采用SPSS13.0软件进行统计学分析,构成比的比较采用χ~2检验,检验水平α=0.05。结果血检三热病人807例,疟原虫血检阳性率为29.6%(239/807),其中,三日疟阳性21例,占8.8%(21/239);21例镜检三日疟原虫阳性者血样中,17例经基因鉴定确诊为三日疟,镜检与基因检测的符合率为81.0%。符合诊断的病例血涂法中寄生疟原虫的红细胞大小正常或稍缩小,可见滋养体和裂殖体期多个虫期形态,滋养体带状形态明显,成熟裂殖体裂殖子6~12个,排列成一环或呈菊花状,经基因鉴定排除三日疟的4例患者血中疟原虫无上述典型形态。完成全程体内观察3例,退热平均时间(16.4±2.5)h,疟原虫无性体转阴平均时间(22.8±3.0)h,完全临床原虫治疗成功率100%,无复燃,未出现明显药物不良反应。结论缅甸北部地区三日疟呈低度流行,形态学结合基因鉴定可提高该地区三日疟确诊率,青蒿琥酯治疗当地三日疟效果较好。
[Abstract]:Objective to investigate the diagnosis and artemisinin treatment of 3-day malaria in northern Myanmar bordering China, and to provide evidence for the prevention and control of 3-day malaria in the border area between China and Myanmar. Methods Blood smears and Plasmodium parasite genes were detected in three fever patients of Kachin State in northern Myanmar. PCR amplification products were sequenced, sequence alignment and homology analysis were performed. Three days malaria patients were treated with artesunate tablets (each tablet containing artesunate 50 g), total dose of 16mg/kg body weight, daily intake of 2mg/kg body weight, taking 7 days, the first dose was doubled, WHO recommended 28 days in vivo method to evaluate its efficacy, establish excel 2007 database, SPSS 13.0 software was used to carry on the statistical analysis, the composition ratio was compared by 蠂 ~ 2 test, the test level was 0.05. Results among 807 patients with triple fever, the positive rate of Plasmodium falciparum was 29.6 / 239 / 807%. Among them, 21 cases were positive for 3 days malaria, accounting for 8. 8% 21% 23 9% of the blood samples of 21 cases. 17 cases were confirmed to be 3 days malaria by gene identification. The coincidence rate between microscopic examination and gene detection was 81. 0%. The erythrocyte size of Plasmodium parasite was normal or slightly smaller in the blood smear method in accordance with the diagnosis. There were several stages of trophozoites and splits, and the trophozoites were obviously zonal, and the mature merozoites were 6-12. The plasmodium in the blood of 4 patients who had been excluded from malaria for three days by gene identification had no typical form of Plasmodium falciparum, which was arranged in a ring or in the shape of chrysanthemum. During the whole course, 3 cases were observed in vivo, the average time of antipyretic and asexual body negative was 16.4 卤2.5hand 22.8 卤3.0hrespectively. The success rate of complete clinical treatment of the parasite was 100 and there was no recurrence and no obvious adverse drug reaction. Conclusion there is a low prevalence of 3-day malaria in northern Myanmar. Morphological combined gene identification can improve the diagnosis rate of three-day malaria in this area. Artesunate is effective in treating local three-day malaria.
【作者单位】：云南省疟疾研究中心云南省虫媒传染病防控研究重点实验室云南省虫媒病毒研究中心云南公共卫生与疾病防控协同创新中心云南省寄生虫病防治所;英国无国界卫生组织德宏项目组;
【基金】：云南省中青年学术技术带头人后备人才项目(No.2015HB075) 登革热等重要虫媒传染病快速检测关键技术研究与防控体系构建(No.15495800400)
【分类号】：R531.3

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