背景:疟疾寄生虫对被感染的宿主具有破坏性影响。然而,关于恶性疟原虫对甲状腺激素的影响的数据很少。
方法:本病例对照研究(1:1)涉及16岁以下无并发症疟疾儿童。使用URIT-5380血液分析仪(中国)测定血液学参数。稍后,甲状腺激素水平,即游离三碘甲状腺原氨酸(fT3),游离四碘甲状腺原氨酸(fT4),促甲状腺激素(TSH),使用人ELISA试剂盒(DiazinoELISA试剂盒,郑州,中国)。
结果:研究了90名疟疾儿童和90名匹配的对照组。总的来说,与对照组相比,较低的TSH(3.43±1.25vs.3.84±1.34,p=0.035)和fT3水平升高(5.85±1.79vs.在疟疾患者中观察到3.89±1.19,p<0.001)。然而,病例组与对照组的fT4水平相当(16.37±2.81vs17.06±3.5,p=0.150)。10岁以下儿童的游离T3水平明显较高(p<0.001),男性疟疾儿童的游离T3水平较高(p<0.001)。总的来说,寄生虫计数与fT3呈显著正相关(R=0.95,p<0.001)。此外,体温与fT3呈正相关(R=0.97,p<0.001)。
结论:在恶性疟疾中观察到孤立的fT3甲状腺毒症,尤其是10岁以下的儿童和男性疟疾患者,独立于TSH。这一观察结果可以解释儿童疟疾的严重程度。
BACKGROUND: Malaria parasites have a devastating effect on the infected host. However, there is a paucity of data on the effect of Plasmodium falciparum on thyroid hormones.
METHODS: This case-control study (1:1) involved children <16 years of age with uncomplicated malaria. Hematological parameters were determined using the URIT-5380 hematology analyzer (China). Later, levels of thyroid hormones, namely free triiodothyronine (fT3), free tetraiodothyronine (fT4), and thyroid-stimulating hormone (TSH), were determined using human ELISA kits (DiaSino ELISA kit, Zhengzhou, China).
RESULTS: Ninety children with malaria and ninety matched control group were studied. Overall, compared to the control group, lower TSH (3.43 ± 1.25 vs. 3.84 ± 1.34, p = 0.035) and elevated levels of fT3 levels (5.85 ± 1.79 vs. 3.89 ± 1.19, p < 0.001) were observed in patients with malaria. However, fT4 levels were comparable between cases and control group (16.37 ± 2.81 vs 17.06 ± 3.5, p = 0.150). Free T3 levels were significantly higher in children <10 years (p < 0.001) and higher among male children with malaria (p < 0.001). Overall, there was a significant positive relationship between parasite counts and fT3 (R = 0.95, p < 0.001). Furthermore, body temperature was positively correlated with fT3 (R = 0.97, p < 0.001).
CONCLUSIONS: Isolated fT3 thyrotoxicosis was observed in falciparum malaria, especially in children <10 years and male malaria patients, independent of TSH. This observation could explain the severity of malaria in children.