疟疾心血管并发症研究进展

Cardiovascular complications in malaria:A review

疟疾作为全球重大公共卫生事件之一,是以非洲撒哈拉以南地区为主的热带、亚热带地区儿童和成人患病及死亡的重要原因,严重威胁人类的健康。疟疾引发的贫血、黑尿热、脑型疟、肾损伤等并发症广为人知。传统意义上,心脏受累并没有被列为影响疟疾发病率和病死率的常见原因,这可能与漏报或诊断不足有关,但其引起的急性冠脉综合征、心力衰竭、恶性心律不齐等严重的临床危害备受关注。目前临床上,抗疟药物使用不当会增加心血管疾病风险,造成严重的后果。该文系统总结了急性心肌梗死、心律失常、高血压病、心力衰竭、心肌炎等疟疾相关心血管并发症的研究进展,从细胞黏附假说、炎症及细胞因子假说、疟原虫诱生毒素致心肌细胞凋亡假说、急性肾功能衰竭继发心脏损伤假说、血栓形成假说等总结了疟疾导致心血管疾病发生的可能机制,并整理了临床常用的喹啉类抗疟药、核蛋白合成抑制类药物、青蒿素及其衍生物对心脏结构和功能的影响。相较于喹啉类药物在抗疟治疗中表现出的心脏毒性,青蒿素类抗疟药物目前在临床应用中未见对心脏的不良影响,而且在预防和治疗心血管疾病方面具有良好的应用前景,有望在心血管基础疾病人群罹患疟疾过程中发挥优势。该文旨在为疟疾心血管并发症防治及抗疟药安全应用提供参考。

Malaria,one of the major global public health events,is a leading cause of mort ality and morbidity among children and adults in tropical and subtropical regions(mainly in sub-Saharan Africa),threatening human health.It is well known that malaria can cause various complications including anemia,blackwater fever,cerebral malaria,and kidney damage.Conventionally,cardiac involvement has not been listed as a common reason affecting morbidity and mortality of malaria,which may be related to ignored cases or insufficient diagnosis.However,the serious clinical consequences such as acute coronary syndrome,heart failure,and malignant arrhythmia caused by malaria have aroused great concern.At present,antimalarials are commonly used for treating malaria in clinical practice.However,inappropriate medication can increase the risk of cardiovascular diseases and cause severe consequences.This review summarized the research advances in the cardiovascular complications including acute myocardial infarction,arrhythmia,hypertension,heart failure,and myocarditis in malaria.The possible mechanisms of cardiovascular diseases caused by malaria were systematically expounded from the hypotheses of cell adhesion,inflammation and cytokines,myocardial apoptosis induced by plasmodium toxin,cardiac injury secondary to acute renal failure,and thrombosis.Furthermore,the effects of quinolines,nucleoprotein synthesis inhibitors,and artemisinin and its derivatives on cardiac structure and function were summarized.Compared with the cardiac toxicity of quinolines in antimalarial therapy,the adverse effects of artemisinin-derived drugs on heart have not been reported in clinical studies.More importantly,the artemisinin-derived drugs demonstrate favorable application prospects in the prevention and treatment of cardiovascular diseases,and are expected to play a role in the treatment of malaria patients with cardiovascular diseases.This review provides reference for the prevention and treatment of malaria-related cardiovascular complications as well as the safe application of antimalarials.