脑型疟的研究新进展.docVIP

脑型疟的研究新进展 　　[摘要] 脑型疟（cerebral malaria，CM）是恶性疟原虫感染所致神经系统并发症，严重危及生命，CM死亡率高，生存的患者持续的脑损伤可表现为长期的认知功能障碍。CM的主要病理学特征是感染疟原虫红细胞（parasitised red blood cells，pRBC）在脑微血管中的滞留、脑实质中的点状、环状出血，以及广泛的脑内皮细胞活化、局灶性内皮细胞损伤和坏死等。但其发病机制至今尚不明确。目前研究认为，脑型疟的发病机制主要包括：pRBC黏附、炎症反应级联、血管渗漏性损伤、脑部缺血缺氧等。研究表明，目前用作CM诊断和预后的生物标志物有（C-X-C motif chemokine ligand 10，CXCL10）、（CXC chemokine ligand 4，CXCL4）、血管生成素（angiopoietin，Ang）等。该文梳理了近年来脑型疟基础及临床研究、药物研究的最新文献，着重从细胞因子、免疫细胞、调控因子、相关生物标志物等方面系统总结近3年脑型疟炎症及免疫机制相关研究进展，为相关研究提供参考。 　　[关键词] 脑型疟； 机制； 炎症； 免疫； 病理； 治疗 　　[Abstract] Cerebral malaria （CM）， a severe neurological syndrome caused by Plasmodium falciparum infection， is a serious life-threatening disease with a high mortality. Survivors′ persistent brain injury is manifested as long-term neurocognitive disorders. The main neuropathological feature of CM is the sequestration of parasited red blood cells （pRBCs） in cerebral microvessels. Other neuropathological features of CM include petechial hemorrhage in the brain parenchyma， annular hemorrhage， extensive brain endothelial cell activation， and focal endothelial cell injury and necrosis. However， its pathogenesis is still not clear. Currently， some studies have suggested that the pathogenesis of cerebral malaria mainly include pRBC adhesion， inflammatory reaction cascade， vascular leakage damage and brain hypoxia. Studies have shown that the biomarkers currently used as diagnostic and prognostic markers for CM include C-X-C motif chemokine ligand 10 （CXCL10）， CXC chemokine ligand 4 （CXCL4）， angiopoietin （Ang）. In this paper， we systematically summarize the basic and clinical research for cerebral malaria in recent years and the latest literatures for drug studies， and focused on the advance of studies on cerebral malaria and its immunologic mechanism in the recent three years in the aspects of cytokines， immune cells， regulatory factors and biomarkers， so as to provide references for relevant studies. 　　[Key words] cerebral malaria； mechanism； inflammation； immune； pa