【摘要】：目的：了解中緬邊境緬甸拉咱市瘧疾流行特征、惡性瘧抗性現(xiàn)狀和治療效果,為中國(guó)第六輪全球基金瘧疾項(xiàng)目制定防治策略提供依據(jù)。方法：在緬甸拉咱市城區(qū)建立研究站,鏡檢發(fā)熱病人和/或疑似瘧疾病例,篩查瘧疾一整年,設(shè)定拉咱市城區(qū)及郊區(qū)4村為研究對(duì)象,進(jìn)行瘧疾流行病學(xué)分析。選擇居住在研究現(xiàn)場(chǎng)內(nèi)的單純惡性瘧現(xiàn)癥患者進(jìn)行抗性研究,用WHO推薦的體外微量試驗(yàn)測(cè)定6種抗瘧藥,用WHO推薦的體內(nèi)試驗(yàn)分別評(píng)價(jià)標(biāo)準(zhǔn)療法的雙氫青蒿素哌喹片和青蒿琥酯片治療惡性瘧的療效,病例觀察28天,治療失敗病例用PCR鑒定復(fù)燃或新感染,矯正治療結(jié)果。結(jié)果：血檢3050人,年血檢陽性率31.2%,流動(dòng)人口年血檢陽性率為30.0%；拉咱市、城區(qū)和郊區(qū)年瘧疾發(fā)病率分別為11.2%、8.9%和21.0%；全年流行,6月和8月是高峰季節(jié)；4種人體瘧原蟲均檢出,以惡性瘧為主占58.1%,間日瘧占39%,偶見三日瘧和卵型瘧,男性發(fā)病是女性的1.6倍,15≤Y20歲組血檢陽性率最高。體外微量測(cè)定43例,成功27例,測(cè)得惡性瘧原蟲對(duì)氯喹、哌喹、咯萘啶、青蒿琥酯、雙氫青蒿素和雙氫青蒿素/哌喹的抗性率分別為100%、0%、25.9%、22.2%、7.4%和0%,半數(shù)抑制濃度(IC50)分別為298.0、49.4、22.3、11.8和5.6/44.8nmol/L。體內(nèi)試驗(yàn)雙氫青蒿素哌喹片和青蒿琥酯片分別納入74例和65例,分別觀察64例和49例,雙氫青蒿素哌喹片100%完全臨床原蟲治療成功,但6.3%的觀察病例D3天有原蟲血癥；青蒿琥酯片治療失敗2例,失敗率為4.1%,該2例PCR鑒定為新感染,矯正療效為100%完全臨床原蟲治療成功,但25.4%的觀察病例D3天和4.1%的觀察病例D4天有原蟲血癥。結(jié)論：拉咱市瘧疾流行嚴(yán)重,屬瘧疾強(qiáng)傳播區(qū),流行以惡性瘧為主,其瘧疾現(xiàn)狀嚴(yán)重威脅中國(guó)邊境地區(qū)和出境流動(dòng)人口。當(dāng)?shù)貝盒辕懺x對(duì)氯喹100%抗性,對(duì)咯萘啶、青蒿琥酯和雙氫青蒿素具有一定程度抗性,對(duì)氯喹、咯萘啶和青蒿琥酯抗性呈逐漸上升趨勢(shì),對(duì)哌喹和雙氫青蒿素/哌喹敏感。雙氫青蒿素哌喹片和青蒿琥酯片治療當(dāng)?shù)貝盒辕懢懓踩行?但青蒿琥酯片清除原蟲血癥過慢,當(dāng)?shù)乜赡艽嬖谀颓噍镧盒辕?但無足夠證據(jù)證明存在抗青蒿琥酯惡性瘧流行。
[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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