两种疗程双氢青蒿素片对恶性疟和间日症疗效的观察

用双氢青蒿素片总量４８ｍｇ分５ｄ和７ｄ两种疗程，分别治疗恶性疟２９和２８例，其平均退热时间各为２７．４±８．８ｈ和２４．０±７．５ｈ；平均原虫无性体转阴时间各为２９．２±７．６ｈ和２９．４±９．０ｈ，观察５０ｈ复燃率各为３１．０％和３．７％。结果表明，两种疗程的临床疗效相似，但远期的复燃率则明显不同（Ｐ＜０．０１）。提示双氢青蒿素片治疗恶性疟的效果明显受其疗程的影响。７ｄ疗程治疗间日疟３６例，其临床疗效与治疗恶性疟相近（Ｐ＞０．０５），但远期复燃率显著较治疗恶性疟高（Ｐ＜０．０１），表明双氢青蒿素片根治间日疟的效果不佳。     

蒿甲醚片治疗疟疾的疗效观察

以蒿甲醚国服片剂，总量６００ｍｇ／ｄ×５在抗氯喹恶性疟流行区治疗恶性疟，间日疟各５２例和３９例，临床治愈率均达１００％，退热时间、疟原虫转阴时间及近期复燃率恶性疟分别为３２．６±１２．８ｈ、３１．９±１２．７ｈ和１４．０％，间日疟分别为２７．９±１５．２ｈ、３３．３±１０．４ｈ和９．７％。结果显示，蒿甲醚片剂治疗恶性疟、间日疟具有与针剂同样高效、速效及不良反应少的优点．     

咯萘啶与磺胺多辛-乙胺嘧啶单剂及两天疗法加伯氨喹治疗恶性疟的效果

目的：在海南省多重抗性恶性疟流行区，观察咯萘啶加伯氨喹与磺胺多辛－乙胺嘧啶加伯氨喹两种方案治疗恶性疟的效果。方法：采用咯萘啶与磺胺多辛－乙胺嘧啶各５００ｍｇ、１０００ｍｇ、５０ｍｇ单剂口服以及３药各８００ｍｇ、１０００ｍｇ、５０ｍｇ２ｄ分服，同时各加伯氨喹４５ｍｇ２ｄ分服，治疗恶性疟各５０例。结果：平均退热时间分别为３９．８±２７．２ｈ和４２．１±２０．５ｈ，原虫无性体转阴时间分别为４６．９±１３．３ｈ和５１．０±１４．２ｈ，２４ｈ减虫率分别为８０％和７８％。２８ｄ治愈率皆为１００％。药物副反应较轻，一般不需特殊处理，但两组各有３例发生溶血反应，心电图有窦性心动过缓或伴窦性心律不齐。结论：表明两种方案均可治愈抗性恶性疟。     

双氢青蒿素与咯萘啶联用治疗恶性疟的初步研究

为提高治疗抗药性恶性疟的治愈率和消除配子体,作者选择了口服双氢青蒿素咯萘啶组合联用。于 １９９６ 年秋,在海南省对氯喹及哌喹的抗性率分别为８０％ 和７０％ 的恶性疟流行区,进行治疗恶性疟的初步观察。双氢青蒿素总剂量２００ｍ ｇ,咯萘啶８００ｍ ｇ,均等分２ 剂,间隔１２－ ２４ｈ服第二剂。共治恶性疟 １０ 例,平均退热时间为２３１±１２７ｈ;无性体原虫平均转阴时间为 ３４４±１００ｈ;药后追踪观察２８ｄ,其中７ 例追踪 ４０ｄ,均未见原虫复燃。治前查见配子体低密度的１ 例,高密度的２ 例,分别于药后ｄ３,ｄ１４ 及 ｄ２０转阴。结果表明,本治疗方案疗程短、治愈率高、可消除配子体,很有前景     

苯芴醇与青蒿琥酯伍用治疗抗药性恶性疟疗效观察

苯芴醇１６００ｍｇ与青蒿琥酯４００ｍｇ３ｄ分服治疗抗药性恶性疟５６例，退热时间３３．３±１４．５ｈ，原虫无性体转阴时间３４．１±９．７ｈ，２８ｄ根治率１００％，无明显不良反应，对配子体形成和原虫孢子增殖有一定抑制效果，疗程和剂量均低于单方组，疗效也较单方组为优，是治疗抗药性恶性疟的适宜方案。     

萘酚喹治疗间日疟的疗效观察

在海南省疟疾流行区，用萘酚喹６００ｍｇ顿服和氯喹１．５ｇ标准疗法各治疗间日疟病人３５例，服药后两组病例均获即时治愈。萘酚喹组平均退热和原虫转阴时间分别为（２２．７±７．４）ｈ和（４６．４±９．７）ｈ；氯喹组平均退热和原虫转阴时间分别为（１９．１±８．３）ｈ和（４１．６±８．２）ｈ。随访６ｗｋ，萘酚喹组的治愈率为１００％，氯喹组为７４．３％。结果表明，萘酚喹治疗间日疟的远期效果明显优于氯喹（Ｐ＜０．０１）。     

环孢素A治疗难治性肾病综合征

目的研究环孢素Ａ（ＣｓＡ）治疗难治性肾病综合征的临床疗效并探讨其机制。方法对３０例肾上腺皮质激素依赖或抵抗的肾病综合征（ＮＳ）患者联合使用了（ＣｓＡ，５ｍｇ·ｋｇ－１·ｄ－１）和泼尼松（３０ｍｇ／ｄ）治疗，并测定了ＣｓＡ治疗前后病人的血生化指标、免疫指标及２４小时尿蛋白排出量。结果２４小时尿蛋白排出量由治疗前的平均７．６７±３．００ｇ／２４ｈ降至治疗后第１、２、３个月的４．９３±３．６４ｇ／２４ｈ、３．５２±２．９４ｇ／２４ｈ、２．２３±１．６０ｇ／２４ｈ；血浆白蛋白由治疗前２７．３±６．４ｇ／Ｌ升至３０．９±８．８ｇ／Ｌ、３４．３±７．６ｇ／Ｌ、３６．０±７．２ｇ／Ｌ；治疗前后血肌酐、ＢＵＮ、尿酸、ＣＤ４／ＣＤ８和可溶性白细胞介素２（ＩＬ２）受体无明显变化，而治疗２个月后外周血单个核细胞产生血清ＩＬ２显著下降。治疗后激素抵抗组ＮＳ完全缓解、部分缓解和无效分别为２２．７％，５０．０％和２７．３％；在激素依赖组分别为５７．１％，４２９％和０。有５例患者因肝肾功能损害或严重腹泻而停用ＣｓＡ。结论本研究提示ＣｓＡ联合小剂量皮质激素治疗难治性肾病综合征，尤其是激素依赖的患者是安全和有效的。     

慢性盐负荷对血压正常盐敏感性个体胰岛素抗性的影响

目的观察慢性盐负荷对血压正常盐敏感者个体胰岛素抗性的影响。方法对２３例血压正常的健康志愿者，通过３天的平衡饮食期（ＮａＣｌ１４ｇ／ｄ），７天的高盐饮食期（ＮａＣｌ２３ｇ／ｄ）及７天的低盐饮食期（ＮａＣｌ３ｇ／ｄ）在确定盐敏感性的同时，进行口服葡萄糖耐量试验及胰岛素释放试验。结果盐敏感者慢性高盐负荷使空腹血胰岛素水平及胰岛素释放量明显增加，与盐不敏感者差异显著，空腹血胰岛素为１２．２±５．７对７．４±１．７μＵ／ｍｌ，胰岛素曲线下面积分别为７４．６±２１．９对３９．０±１２．４μＵ·ｈ－１·Ｌ－１，Ｐ均＜０．０５；敏感者高盐负荷后与平衡饮食期相比，葡萄糖负荷试验后的１ｈ及曲线下面积亦有升高倾向。结论高盐摄入在升高盐敏感者血压的同时，胰岛素抗性也增加     

青蒿琥酯与伯喹联用对间日疟的疗效

在云南南部，用青蒿琥酯６００ｍｇ、伯喹１８０ｍｇ和氯喹１５００ｍｇ、伯喹１８０ｍｇ，均以８ｄ分服，分别治疗３３例和３５例间日疟患者，平均退热时间各为（１８．７±３．９）ｈ和（２５．４±１２．０）ｈ，平均原虫转阴时间各为（２８．７±６．１）ｈ和（４２．９±６．２）ｈ。观察９个月内的复发率分别为３３．３％和２２．９％。结果表明，青蒿琥酯与伯喹联用治疗间日疟，其退热时间和原虫转阴时间均显著快于氯喹与伯喹联用组（Ｐ均＜０．０１），而复发率则无明显差别（Ｐ＞０．０５），且副反应更轻，患者易于接受。因此，是治疗间日疟的安全有效方案。     

磷酸咯萘啶与复方磺胺多辛、伯喹伍用治疗抗氯喹地区恶性疟疗效的进一步观察

磷酸咯萘啶８００ｍｇ（基质）与复方磺胺多辛２片，伯喹４５ｍｇ（基质）伍用，在抗氯喹恶性疟流行区治疗恶性疟４２例，平均退热时间３９．０±１７．３ｈ，平均原虫无性体转阴时间４１．５±１３．６ｈ。服药后４８ｈ疟原虫无性体下降率为９７．６—１００％，２８天内复燃率为１０．３％（３／２９）；治后５天内配子体清除率达８７．５％。与５年前的疗效相似。显示该方案并不随恶性疟原虫对咯萘啶的敏感性下降而下降，当地临床观察证实恶性疟原虫对复方磺胺多辛、乙胺嘧啶的抗性率达４１．７％。     

以皮疹、腹泻为首发症状的脑型疟1例

非洲地区是疟疾的高流行地区,其中恶性疟的发病率和病死率最高.本文通过报道我国援坦桑尼亚医疗队诊治的1例以皮疹和腹泻为首发症状的脑型恶性疟患者的体会,以期为临床医生在诊治疟疾时提供参考、借鉴.     

Parasite-specific lactate dehydrogenase for the diagnosis of Plasmodium falciparum infection in an endemic area in West Uganda

The measurement of parasite lactate dehydrogenase (pLDH) has been presented as an easy and rapid method for the diagnosis of malaria in humans. In order to evaluate the sensitivity and specificity of such a test we examined blood samples from 429 Ugandan patients. While pLDH activity was significantly linked to parasitaemia, sensitivity and specificity were found to be rather low at 58.8 and 62.2% respectively. The positive and negative predictive values failed to meet necessary standards. We conclude that the methods of measurement of pLDH activity in malaria infection, although potentially useful for the fast diagnosis of malaria, need to be improved to be of true value in endemic areas.     

江汉平原控制间日疟对策的研究

从１９８６年开始，在江汉平原有代表性的江陵县境内２５万人口范围地区，研究控制间日疟的对策，经过实施以根治传染源和消除病灶点为主的综合性措施，该范围内的发病率由１９８６年的１１．５６‰下降到１９９１年的０．２８‰，为江汉平原广大流行区控制疟疾提供了科学依据。     

Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya

Summary objective  To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya.
method  In a population-based case-control study, 51 travellers from Bavaria diagnosed with falciparum malaria imported from Kenya (cases) and a sample of 383 healthy Bavarian travellers returning from Kenya (controls) were interviewed. Data were analysed by multiple logistic regression.
results  Mefloquine (OR = 0.055; 95% Cl 0.019-0.16) and chloroquine combined with proguanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.225; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-prophylaxis (11.2%) were the main reasons for malaria importation. Travelling alone or with friends, male sex, and travel duration over 4 weeks could be identified as additional risk factors. The main reason for inadequate chemoprophylaxis was inappropriate medical advice (87.5%). Prophylaxis refusal occurred frequently despite correct advice (58.1%). Diagnosis was often delayed unnecessarily (27.5%).
conclusion  Malaria importation from Kenya could be reduced substantially (34%) by eliminating inappropriate medical advice.     

Mononeme: a new secretory organelle in Plasmodium falciparum merozoites identified by localization of rhomboid-1 protease

Compartmentalization of proteins into subcellular organelles in eukaryotic cells is a fundamental mechanism of regulating complex cellular functions. Many proteins of Plasmodium falciparum merozoites involved in invasion are compartmentalized into apical organelles. We have identified a new merozoite organelle that contains P. falciparum rhomboid-1 (PfROM1), a protease that cleaves the transmembrane regions of proteins involved in invasion. By immunoconfocal microscopy, PfROM1 was localized to a single, thread-like structure on one side of the merozoites that appears to be in close proximity to the subpellicular microtubules. PfROM1 was not found associated with micronemes, rhoptries, or dense granules, the three identified secretory organelles of invasion. Release of merozoites from schizonts resulted in the movement of PfROM1 from the lateral asymmetric localization to the merozoite apical pole and the posterior pole. We have named this single thread-like organelle in merozoites, the mononeme.     

Risk associated with asymptomatic parasitaemia occurring post-antimalarial treatment

Objective  Parasites may recur asymptomatically after initial clearance by antimalarial treatment. Current guidelines recommend treatment only when patients develop symptoms or at the end of follow-up. We wanted to assess prospectively the probability of becoming symptomatic and the risks of this practice.
Methods  We analysed data collected in 13 trials of uncomplicated paediatric malaria conducted in eight sub-Saharan African countries. These studies followed all cases of post-treatment asymptomatic parasitaemia until they developed symptoms or to the end of the 28-day follow-up period, at which time parasite genotypes were compared to pre-treatment isolates to distinguish between recrudescences and new infections.
Results  There were 425 asymptomatic recurrences after 2576 treatments with either chloroquine, sulfadoxine/pyrimethamine or amodiaquine, of which 225 occurred by day 14 and 200 between day 15 and day 28. By day 28, 42% developed fever (median time to fever = 5 days) and 30% remained parasitaemic but afebrile, while 23% cleared their parasites (outcome unknown in 4%). Young age, parasitaemia ≥500 parasites/μl; onset of parasitaemia after day 14, and treatment with amodiaquine were the main variables associated with higher risk of developing fever.
Conclusion  In areas of moderate to intense transmission, asymptomatic recurrences of malaria after treatment carry a substantial risk of becoming ill within a few days and should be treated as discovered. Young children are at higher risk. The higher risk carried by cases occurring in the second half of follow-up may be explained by falling residual drug levels.     

贵州省凯里等12个基本消灭疟疾县（市）的监测结果

目的：评价本地区基本消灭疟疾９年来的监测结果。方法：采用传统的疟疾度量调查各项指标。结果：（１）年带虫发病率波动在０．００５６‰至０．０００３３‰间；（２）居民发热病人血检阳性率平均为０．７３，居民普查原虫率平均为０．８２；（３）流动人口发热病人血检阳性率及原虫率分别为４１３．１和７．０６；（４）在９９４个疫点中，活动性疫点占１０．７％。结论：输入病例是疟疾病例的主要来源（９３．４％），仍需继续加强流动人口的管理。     

输入性恶性疟1例血液学筛查并文献复习

本文报道1例输入性恶性疟的血液学筛查和原虫形态学特征, 并结合文献进行复习。     

The immunology of malaria—a view from the bush

During the past few years a great deal has been learnt about malaria parasites and the immune responses that they evoke in their hosts. However, this new knowledge has so far had little impact on the practical problems of malaria control in tropical developing countries where malaria is still responsible for much mortality and morbidity. In Africa the malaria situation is now more serious than it was 20 years ago. Exciting new developments in molecular biology suggest that this situation may change in a few years time but attempts should be made to put the advances that have been made to the best practical use as soon as possible rather than delaying until even better technologies have been developed. This approach will require close collaboration between immunologists in sophisticated laboratories in industrialised countries and smaller laboratories in the countries of the developing world where malaria is still a major problem.