Effect of Iron Chelation Therapy on Recovery from Deep Coma in Children with Cerebral Malaria

作者：Victor R. Gordeuk, Philip E. Thuma, Gary M. Brittenham, Christine E. McLaren, Dean Parry, Anita Backenstose, Godfrey Biemba, Roland Msiska, Laura M. Holmes, Elizabeth D. McKinley, Linda Vargas, Robert Gilkeson, A.A. Poltera · 发表于：New England Journal of Medicine · 年份：1992 · DOI：10.1056/nejm199211193272101 · 被引用次数：218 · 研究领域：Malaria Research and Control、Epilepsy research and treatment、Sleep and Wakefulness Research

BACKGROUND: Cerebral malaria is a severe complication of Plasmodium falciparum infection in children, with a mortality rate of 15 to 50 percent despite antimalarial therapy. METHODS: To determine whether combining iron chelation with quinine therapy speeds the recovery of consciousness, we conducted a randomized, double-blind, placebo-controlled trial of the iron chelator deferoxamine in 83 Zambian children with cerebral malaria. To be enrolled, patients had to be less than six years old, have P. falciparum parasitemia, have normal cerebrospinal fluid without evidence of bacterial infection, and be in a coma from which they could not be aroused. Deferoxamine (100 mg per kilogram of body weight per day, infused intravenously for 72 hours) or placebo was added to standard therapy with quinine and sulfadoxine-pyrimethamine. The time to the recovery of full consciousness, time to parasite clearance, and mortality were examined with Cox proportional-hazards regression analysis. RESULTS: The rate of recovery of full consciousness among the 42 patients given deferoxamine was 1.3 times that among the 41 given placebo (95 percent confidence interval, 0.7 to 2.3); the median time to recovery was 20.2 hours in the deferoxamine group and 43.1 hours in the placebo group (P = 0.38). Among 50 patients with deep coma, the rate of recovery of full consciousness was increased 2.2-fold with deferoxamine (95 percent confidence interval, 1.1 to 4.7), decreasing the median recovery time from 68.2 ...