磷酸萘酚喹与甲氟喹和青蒿琥酯治疗恶性疟疗效的随机比较

A randomized comparative study of naphtoquine,mefloquine and artsunate in the treatment of falciparum malaria

目的 评价磷酸萘酚喹、甲氟喹、青蒿琥酯的疗效及副反应。方法 90例普通恶性疟疾病人入选 ,年龄 6～ 5 0岁 ,采用磷酸萘酚喹 2 4h总量 10 0 0mg与甲氟喹 75 0mg一次顿服 ,青蒿琥酯片 5d疗程总量 6 0 0mg。各治疗恶性疟 30例 ,进行随机比较。结果 3组病例均能控制临床症状 ,平均退热时间磷酸萘酚喹组 30h± 16h与甲氟喹组 2 4h± 15h相近 (P >0 0 5 ) ,较青蒿琥酯 18h± 9h慢(P <0 0 1)。平均原虫转阴时间磷酸萘酚喹组 (98h± 2 8h)较甲氟喹组 (5 7h± 2 0h)慢 (P <0 0 1) ,较青蒿琥酯组 (43h± 17h)更慢 (P <0 0 1)。追踪观察 2 8d ,磷酸萘酚喹组治愈率 (96 7% )较甲氟喹组(76 7% )高 (P <0 0 5 ) ,较青蒿琥酯组 (73 3% )高 (P <0 0 5 )。 3组除极少数患者有轻微短暂恶心、呕吐外 ,未见明显毒副反应。结论 磷酸萘酚喹 2 4h总量 10 0 0mg治疗恶性疟的退热时间、原虫转阴时间较甲氟喹 75 0mg一次顿服、青蒿琥酯 5d疗程总量 6 0 0mg慢 ,但 2 8d治愈率高于甲氟喹组和青蒿琥酯组。建议采用青蒿琥酯与萘酚喹或甲氟喹组成复方以提高疗效、缩短疗程 ,并延缓抗药性发生。

Objective To evaluate the efficacy and safety of naphtoquine, compared with mefloquine and artesunate in the treatment of falciparum malaria. Method Ninety patients with falciparum malaria were randomly allocated to 3 groups, including naphtoquine, mefloquine and artesunate group. In the naphtoquine group, thirty patients were prescribed single daily dosage of 1 000 mg for one day. In the mefloquine group, equal patients were treated with single dosage of 750 mg. Another thirty patients in the artesunate group were given total dosage of 600 mg for five days and doubling dosage on the first day. Result In all three groups, sympotoms were well controled. The average fever-subsidence time in naphtoquine group was 30 h±16 h and approximate that in mefloquine group(24 h±15 h, P >0.05), but was longer than that in maphtoquine group(18 h±9 h, P <0.01). The average parasite-clearance time in naphtoquine group (98 h±28 h)is longer than that in mefloquine group(57 h±20 h, P <0.01) and that in artesunate group(43 h±17 h, P <0.01). At the end of 28-day clinical trail, the curative ratio in naphtoquine group was the highest(96.7%), and was significantly higher than that in mefloquine group(76.7%, P <0.05) and artesunate group(73.3%, P <0.05). Slight nausea and vomiting were observed in few patient in three groups. Conclusion Although the average fever-subsidence time and the parasite-clearance time of naphtoquine at single 24-hour dosage of 1 000 mg were longer than those of mefloquine and artesunate, the 28-day curative ratio of naphtoquine was higher than that of mefloquine and artesunate. So we recommend that the combination of artemisinin, which is a rapid action antimalarial, and naphtoquine or mefloquine,which are longterm action antimalarial, would contribute to promoting efficacy, shorting the period of treatment and delaying occurrence of drug resistance.