恶性疟原虫对青蒿素的抗性与延缓抗性的建议

抗疟药可以起到治疗病人、保护人群、消灭传染源和阻断传播的作用,是疟疾防治的重要武器。疟原虫为生存繁殖与抗疟药开展殊死斗争,主要表现是产生抗性。本文就疟原虫对当前治疗恶性疟的一线青蒿素类药物抗性研究现状加以评述,提出延缓抗性建议。研究发现恶性疟原虫对青蒿素的敏感性已经下降,柬埔寨、泰柬、泰缅、缅甸、越南等地发现ACTs治愈率下降,治疗失败病例增加;目前的研究结果,还缺乏证实恶性疟原虫对青蒿素产生了抗性的充分的证据;治疗失败不等于抗性(可能包含抗性病例),多数病例都是通过青蒿素延长疗程增加剂量而获得治愈。青蒿素治疗指数高,提高1~2倍剂量也是安全的,建议增加剂量,疗程延长至4~5 d,以提高治愈率,延缓抗性。重点地区重点人群开展疗效评价和抗性监测;全程足量规范使用青蒿素类药物;线索追踪,清点拔源;防止输入性青蒿素抗性恶性疟扩散等对策可以有效延缓和遏制恶性疟原虫对青蒿素的抗性。建议继续推广应用,并不断完善。

Plasmodium falciparum resistance to artemisinin and suggestions on slowing down resistance development

Anti-malarial drugs are an important weapon for treating patients,protecting people,eradicating infectious resources and interrupting transmission in malaria control.The resistance is a kind of malaria parasite way for survival and reproduction.This paper reviews the resistance situation of the first line drugs for falciparum malaria treatment,and then presents suggestions on how to delay resistance development.The results of researches found the decreased artemisinin sensitivity in Plasmodium falciparum and cure rates,increased number of treatment failure cases in Canbodia,Myanmar,Vietnam and Thailand-Cambodian-Myanmar border.However,these research results can still not be used to confirm fully resistant P.falciparum to artemisinin.The treatment failure does not mean or equal to the resistance.Most treatment failure cases (maybe including resistant cases) have been cured by increasing the dosages and longer treatment courses.Artemisinin has a high safety,and double dosing is still safe.It is suggested that World Health Organization and Chinese related authorities can recommend increasing the dosage and using 4-5 d treatment courses,which may increase the cure rates and delay the resistance development.However,this needs to carry out therapeutic efficacy study and resistance surveillance,and fully appropriate use of artemisinin.The strategies of investigation and clearing up of malaria foci in time,prevention from imported artemisinin resistant falciparum malaria and its spread can effectively slow down the artemisinin resistance development in P.falciparum.It is suggested continuously scaling up and improving the strategy.