我国恶性疟原虫对青蒿素类药物的敏感性监测

Monitoring of the sensitivity of Plasmodium falciparumto artemisinin-based drugs in China

目的监测恶性疟原虫对青蒿素类药物的敏感性,为合理使用抗疟药提供参考。方法在研制成功涂药板和便于现场使用的培养基后,采用世界卫生组织(WHO)推荐的体外微量法,开展了恶性疟原虫对青蒿琥酯、双氢青蒿素、蒿甲醚及蒿乙醚等药物的敏感性监测。结果海南省乐东县监测的完全抑制疟原虫裂殖体形成的平均药浓度,1986年为0.028pmol/μl,2002年上升至0.135pmol/μl(P<0.01);≥4pmol/μl完全抑制裂殖体形成例数所占百分比,由1986年的5.5%上升至2002年为21.8%(0.025<P<0.01)。云南省勐腊县、中-缅边境和中-老边境地区测得的完全抑制疟原虫裂殖体形成的平均药浓度,分别为6.8nmol/L^11.1nmol/L、32nmol/L和46nmol/L;≥4pmol/μl完全抑制裂殖体形成例数所占百分比,分别为4.5%、16.7%和12.1%。结论海南省和云南省的中-缅边境和中-老边境地区恶性疟原虫对青蒿素类药物的敏感性在逐渐下降。

Objective To monitor the sensitivity of Plasmodium falciparumto artemisinin derivatives in order to allow rational use of antimalarials. Methods Microplates and medium for field used were successfully prepared and then an in vitro micro assay recommended by the WHO was used to ascertain the sensitivity of P.falciparumto artesunate,dihydroartemisinin,artemether,and arteether. Results In Ledong County,Hainan Province,the mean concentration of artesunate for complete inhibition of schizont formation increased from 0.028pmol/μl in 1986 to 0.135pmol/μl in 2002（P〈0.01）,and the proportion of samples without schizont formation in the presence of≥4pmol/μl of artesunate increased from 5.5%in 1986 to 21.8%in 2002（0.025〈P〈0.01）.The mean concentration of artesunate for complete inhibition of schizont formation was 6.8nmol/L-11.1nmol/L in Mengla County,32nmol/L on the China-Myanmar border,and 46nmol/L on the China-Laos border of Yunnan Province.The proportion of samples with complete inhibition of schizont formation in the presence of≥4pmol/μl of artesunate was 4.5%in Mengla County,16.7% on the China-Myanmar border,and 12.1% on the China-Laos border of Yunnan Province. Conclusion The sensitivity of P.falciparum to artemisinin-based drugs has gradually decreased in Hainan Province,on the China-Myanmar border,and on the ChinaLaos border of Yunnan Province.