缅甸拉咱市疟疾流行特征及恶性疟抗性研究

发布时间：2019-05-23 03:56

【摘要】：目的：了解中缅边境缅甸拉咱市疟疾流行特征、恶性疟抗性现状和治疗效果,为中国第六轮全球基金疟疾项目制定防治策略提供依据。方法：在缅甸拉咱市城区建立研究站,镜检发热病人和/或疑似疟疾病例,筛查疟疾一整年,设定拉咱市城区及郊区4村为研究对象,进行疟疾流行病学分析。选择居住在研究现场内的单纯恶性疟现症患者进行抗性研究,用WHO推荐的体外微量试验测定6种抗疟药,用WHO推荐的体内试验分别评价标准疗法的双氢青蒿素哌喹片和青蒿琥酯片治疗恶性疟的疗效,病例观察28天,治疗失败病例用PCR鉴定复燃或新感染,矫正治疗结果。结果：血检3050人,年血检阳性率31.2%,流动人口年血检阳性率为30.0%；拉咱市、城区和郊区年疟疾发病率分别为11.2%、8.9%和21.0%；全年流行,6月和8月是高峰季节；4种人体疟原虫均检出,以恶性疟为主占58.1%,间日疟占39%,偶见三日疟和卵型疟,男性发病是女性的1.6倍,15≤Y20岁组血检阳性率最高。体外微量测定43例,成功27例,测得恶性疟原虫对氯喹、哌喹、咯萘啶、青蒿琥酯、双氢青蒿素和双氢青蒿素/哌喹的抗性率分别为100%、0%、25.9%、22.2%、7.4%和0%,半数抑制浓度(IC50)分别为298.0、49.4、22.3、11.8和5.6/44.8nmol/L。体内试验双氢青蒿素哌喹片和青蒿琥酯片分别纳入74例和65例,分别观察64例和49例,双氢青蒿素哌喹片100%完全临床原虫治疗成功,但6.3%的观察病例D3天有原虫血症；青蒿琥酯片治疗失败2例,失败率为4.1%,该2例PCR鉴定为新感染,矫正疗效为100%完全临床原虫治疗成功,但25.4%的观察病例D3天和4.1%的观察病例D4天有原虫血症。结论：拉咱市疟疾流行严重,属疟疾强传播区,流行以恶性疟为主,其疟疾现状严重威胁中国边境地区和出境流动人口。当地恶性疟原虫对氯喹100%抗性,对咯萘啶、青蒿琥酯和双氢青蒿素具有一定程度抗性,对氯喹、咯萘啶和青蒿琥酯抗性呈逐渐上升趋势,对哌喹和双氢青蒿素/哌喹敏感。双氢青蒿素哌喹片和青蒿琥酯片治疗当地恶性疟均疟安全有效,但青蒿琥酯片清除原虫血症过慢,当地可能存在耐青蒿琥酯恶性疟,但无足够证据证明存在抗青蒿琥酯恶性疟流行。
[Abstract]:Objective: to investigate the epidemic characteristics, falciparum malaria resistance and therapeutic effect of malaria in Razan, Myanmar, along the border with China, and to provide the basis for the sixth round of global fund malaria control strategy in China. Methods: a research station was set up in the urban area of Lazan City, Myanmar. The febrile patients and / or suspected malaria cases were examined by microscopic examination, and the malaria was screened for a whole year. Four villages in the urban and suburban areas of Lazan City were selected as the subjects for epidemiological analysis of malaria. The resistance of patients with falciparum malaria living in the study site was studied, and six kinds of anticalarial drugs were determined by the in vitro microtest recommended by WHO. The efficacy of dihydroartemisinin praziquine tablets and artesunate tablets recommended by WHO in the treatment of falciparum malaria was evaluated by in vivo trial recommended by WHO. The patients with failure were observed for 28 days. PCR was used to identify reburning or new infection and correct the treatment results. Results: the positive rate of annual blood test was 31.2%, the positive rate of floating population was 30.0%, and the annual incidence of malaria was 11.2%, 8.9% and 21.0% respectively in Lazan city, urban area and suburbs, and the annual positive rate of blood test was 31.2%, 30.0% in floating population, 11.2% in urban area and 21.0% in suburbs. It is popular all year round, and June and August are the peak seasons. Plasmodium falciparum and Plasmodium vivax accounted for 58.1% and 39% respectively. Occasionally, Plasmodium vivax and oocyte malaria were occasionally found. The incidence of Plasmodium vivax in male was 1.6 times higher than that in female. The positive rate of blood test was the highest in 15 鈮，

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