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題 名 | 瘧疾的青蒿素抗藥性現況與基因分析=Current Status and Genetic Analysis of Artemisinin Resistance in Malaria |
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作 者 | 李淑英; 亞倫.尼爾; 林子琦; 盧欣嶸; 鄧華真; 許珍禎; 許世芬; | 書刊名 | 疫情報導 |
卷 期 | 36:24 2020.12.22[民109.12.22] |
頁 次 | 頁387-392 |
分類號 | 412.42 |
關鍵詞 | 瘧疾; 惡性瘧; 青蒿素; 抗藥性; Malaria; Plasmodium falciparum; Artemisinin; Resistance; |
語 文 | 中文(Chinese) |
中文摘要 | 瘧疾(malaria)迄今仍為重要公衛議題,以青蒿素(Artemisinin) 為基礎的聯合療法 (Artemisinin-based combination therapies, ACTs),療效極佳,已被世界衛生組織推薦為一線治療惡性瘧原蟲感染。 2008年以來,在大湄公河次區域 (Greater Mekong Subregion) 陸續出現對ACT抗藥性的報導。ACTs的療效隨著普遍使用而逐漸下降。現今全球密切關心青蒿素抗藥性以及ACT多重抗藥性的傳播。PfKelch-13基因的變異是產生Artemisinin 抗藥性的原因之一,本文建立pfK13基因的多型性監測,並初步評估2018年分別由肯亞、索羅門群島、烏干達境外移入臺灣的4例惡性瘧對青蒿素的抗藥性,結果發現pfK13基因皆無突變。 為了防堵瘧疾境外移入,除透過臨床觀察及旅遊史詢問,血液抹片鑑定及後續追蹤外,對於來自抗藥性疫區,且治療後血中瘧原蟲仍未完全清除者,須考慮可能是抗藥性瘧疾之情形產生。必要時結合瘧疾抗藥性基因定序,以適時調整治療策略。這些結果可更有效的管理抗瘧藥物的使用,延緩抗藥性的產生並維持青蒿素的有效性。 |
英文摘要 | Malaria is still an important public health issue to date. Artemisinin-based combination therapies (ACTs) are highly effective and have been recommended by the World Health Organization as the first-line treatment for Plasmodium falciparum infection. Since 2008, ACT resistance has been reported in the Greater Mekong Subregion. The efficacy of ACTs has gradually decreased with its widespread use. Now the world is deeply concerned with the spreading of artemisinin resistance and ACT multidrug resistance. Mutations in the propeller domain of the P. falciparum kelch13 (pfK13) gene are associated with artemisinin resistance. In order to assess the artemisinin resistance of imported malaria in Taiwan, we sequenced pfK13 gene of four falciparum malaria cases imported from Kenya, Solomon Islands and Uganda in 2018 and no mutations were found in pfK13 gene. To better cope with imported malaria cases, measures such as clinical observations, travel history inquiry, laboratory diagnosis and follow-up should be reinforced. In addition, for patients from Greater Mekong Subregion with parasitemia after therapy regimen, the possibility of resistance should be evaluated, and malaria drug resistance genes, such as pfKelch‐13 gene, should be sequenced to assess the resistance of artemisinin for timely adjustment of treatment strategies. These efforts assist in more rational use of antimalarial drugs, delay the development of drug resistance and maintain the effectiveness of artemisinin. |
本系統中英文摘要資訊取自各篇刊載內容。