摘要
脑型疟(cerebral malaria,CM)是恶性疟原虫感染引起的最致命的并发症,即使经过有效抗疟药物治疗,儿童死亡率仍可高达18%,且有近三分之一的幸存者会出现神经功能缺损和认知障碍。目前CM的发病机制尚不明确,机械阻塞和免疫学说是其主流学说。CM辅助治疗的主要目的是改善临床结果和/或降低死亡率,以及预防长期神经认知缺陷。提高生存率和减少幸存者的神经损伤是新型抗疟药与辅助治疗的新策略。本文从保护血管内皮、减轻黏附阻塞效应、调节免疫平衡、干扰疟原虫代谢、神经保护、提高NO生物利用度、改善能量代谢、减轻炎症等方面,对近5年CM辅助治疗研究的进展进行系统总结,为CM的相关研究提供参考。
Cerebral malaria(CM)is the deadliest complication of Plasmodium falciparum infection and even with effective anti-malarial treatment the mortality of children can be as high as 18%;up to one-third of CM survivors are left with neurological and cognitive deficits.The pathophysiology of CM is not completely understood,but mechanical obstruction and immunopathology are its mainstream theories.Adjuvant therapy aims to improve clinical outcomes and/or reduce mortality,as well as preventing long-term neurocognitive deficits.Improving survival and reducing neurological damage to survivors are new goals for new antimalarials and adjuvant therapies.Herein,we discussed what is known about the disease mechanism of CM and systematically summarize the progress of adjuvant therapy research in protecting the vascular endothelium,reducing adhesion formation,regulating immune balance,interfering with malarial metabolism,protecting nerves,improving nitric oxide bioavailability,improving energy metabolism and alleviating inflammation,with the aim of exploiting this understanding to reduce the neurological damage to children with CM.This work also highlights some preclinical studies which may be candidate strategies in future clinical trials.
作者
姜晓慧
郑钟原
刘慧
杨婷
瞿水清
李玉洁
陈利娜
JIANG Xiao-hui;ZHENG Zhong-yuan;LIU Hui;YANG Ting;QU Shui-qing;LI Yu-jie;CHEN Li-na(Artemisinin Research Center,China Academy of Chinese Medical Sciences,Beijing 100700,China;Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China)
出处
《药学学报》
CAS
CSCD
北大核心
2020年第2期208-217,共10页
Acta Pharmaceutica Sinica
基金
中国中医科学院十三五重点领域项目(Z2017021)
国家重大新药创制科技重大专项(2017ZX09101002-001-001-3)
国家自然科学基金特别资助项目(81641002)
中央级公益性科研院所基本科研业务费专项资金资助(L2017001)
关键词
脑型疟
发病机制
神经后遗症
辅助治疗
新策略
cerebral malaria
pathogenesis
neurological sequelae
adjuvant therapy
new strategy
