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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。
Anti-malarial drugs can play an important role in the prevention and treatment of malaria by treating patients, protecting people, eliminating sources of infection and blocking transmission. Plasmodium struggle for survival and reproduction with anti-malaria drugs, the main manifestation of resistance. This article reviews the status quo of Plasmodium resistance research on the first-line artemisinin resistance in the treatment of falciparum malaria and proposes the suggestion of delaying the resistance. The study found that the susceptibility of Plasmodium falciparum to artemisinin has decreased, Cambodia, Thailand and Cambodia, Thailand and Myanmar, Myanmar, Vietnam and other places found ACTs cure rate decreased, treatment failure cases increased; the current findings, but also the lack of confirmation of Plasmodium falciparum Adequate evidence of resistance to artemisinin; treatment failure does not equal resistance (which may include resistant cases), and most cases are cured by increasing doses of artemisinin to prolong the course of treatment. Artemisinin treatment index is high, increase 1 to 2 times the dose is also safe, it is recommended to increase the dose, treatment extended to 4 ~ 5 d, in order to improve the cure rate and delay the resistance. Key areas of key populations to carry out the evaluation of efficacy and resistance monitoring; full use of artemisinin-based drugs in sufficient quantities; clues to track and count the source of pull; to prevent imported artemisinin-resistant spread of falciparum malaria and other strategies can effectively delay and contain falciparum malaria Protozoan resistance to artemisinin. Proposed to continue to promote the application, and continue to improve.