NEJM:颅内压增高为脑型疟疾患儿死因

2015-03-21 MedSci MedSci原创

背景:患脑性疟疾的非洲儿童病死率范围在15%到25%,关键的发病经过和死因尚不明确。但是结合临床观察和病理结果表明,患脑性疟疾的非洲儿童死因很可能是因为脑内容物增加导致颅内压增高。2009年在马拉维可使用核磁共振(MRI)研究,因此,我们使用MRI来探讨并研究脑水肿在脑性疟疾的非洲儿童的发病机制。研究方式:我们对患脑型疟疾的非洲儿童进行了严格的筛选并登记,有详细而明确的脑型疟疾的标准(包括视网膜病

背景:


患脑性疟疾的非洲儿童病死率范围在15%到25%,关键的发病经过和死因尚不明确。但是结合临床观察和病理结果表明,患脑性疟疾的非洲儿童死因很可能是因为脑内容物增加导致颅内压增高。2009年在马拉维可使用核磁共振(MRI)研究,因此,我们使用MRI来探讨并研究脑水肿在脑性疟疾的非洲儿童的发病机制。

研究方式:

我们对患脑型疟疾的非洲儿童进行了严格的筛选并登记,有详细而明确的脑型疟疾的标准(包括视网膜病变),观察他们的临床表现、做MRI之后收入院并观察每天的持续昏迷情况。

结果:

我们经过严格筛查之后从348名患脑型疟疾的非洲儿童选取登记并分析了168名儿童(按照世界卫生组织对脑型疟疾的定义)。我们对这168名儿童进行了详细的研究和调查,其中有25名儿童死亡(占总人数的15%),这25名儿童有21名在MRI中可以发现明显的脑水肿表现;相比之下,在幸存的143名儿童中有39名儿童MRI显示明显的脑水肿变化(占幸存者的27%),串行MRI显示之前有过脑水肿的幸存者病愈后脑容量会减少。

结论:

实验表明,死于脑型疟疾的非洲儿童死因大多为脑内容物增加,除此之外引起脑型疟疾儿童死亡的死因较罕见。这一发现表明,颅内压的增大可能导致患脑型疟疾的非洲儿童死亡。曾经的自然研究结果表明,脑型疟疾幸存患儿颅内压增高持续短暂,因此,若要提高脑型疟疾患儿生存率,必须降低颅内压。

脑型疟疾是人类中枢神经系统中最常见、最严重的寄生虫感染性疾病。据估计,仅非洲撒哈拉沙漠以南,每年都有约80万人死于恶性疟疾。 脑型疟疾是一种常见而且严重的中枢神经系统感染,在发展中国家,脑型疟疾是导致死亡和神经系统疾病的重要原因,在发达国家,也发现其对去热带地区的旅游者影响与日俱增。

原始出处:
Seydel KB, Kampondeni SD, Valim C, Potchen MJ, Milner DA, Muwalo FW, Birbeck GL, Bradley WG, Fox LL, Glover SJ, Hammond CA, Heyderman RS, Chilingulo CA, Molyneux ME, Taylor TE. swelling and death in children with cerebral malaria. N Engl J Med. 2015 Mar 19;372(12):1126-37.

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    2015-03-23 liuxiaona
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    2015-03-23 liuxiaona
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    2015-03-22 lovetcm

    这个研究看起来简单,但开创了对脑疟的病理认识

    0

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