Malaria, mostly due to Plasmodium falciparum infection in Africa, remains one of the most important infectious diseases in the world. Standard treatment for uncomplicated P. falciparum malaria is artemisinin-based combination therapy (ACT), which includes a rapid-acting artemisinin derivative plus a longer-acting partner drug, and standard therapy for severe P. falciparum malaria is intravenous artesunate. The efficacy of artemisinins and ACT has been threatened by the emergence of artemisinin partial resistance in Southeast Asia, mediated principally by mutations in the P. falciparum Kelch 13 (K13) protein. High ACT treatment failure rates have occurred when resistance to partner drugs is also seen. Recently, artemisinin partial resistance has emerged in Rwanda, Uganda and the Horn of Africa, with independent emergences of different K13 mutants in each region. In this Review, we summarize our current knowledge of artemisinin partial resistance and focus on the emergence of resistance in Africa, including its epidemiology, transmission dynamics and mechanisms. At present, the clinical impact of emerging resistance in Africa is unclear and most available evidence suggests that the efficacies of leading ACTs remain excellent, but there is an urgent need to better appreciate the extent of the problem and its consequences for the treatment and control of malaria.

疟疾主要由非洲的恶性疟原虫感染引起，仍然是世界上最重要的传染病之一。无并发症的恶性疟原虫疟疾的标准治疗是基于青蒿素的联合疗法（ACT），其中包括速效青蒿素衍生物加长效伙伴药物，而严重恶性疟原虫疟疾的标准治疗是静脉注射青蒿琥酯。青蒿素和 ACT 的疗效受到东南亚青蒿素部分耐药性的威胁，这种耐药性主要是由恶性疟原虫Kelch 13 (K13) 蛋白突变介导的。当同时发现对伙伴药物的耐药性时，ACT 治疗失败率就会很高。最近，卢旺达、乌干达和非洲之角等地出现了青蒿素部分耐药性，每个地区都独立出现了不同的K13突变体。在这篇综述中，我们总结了目前对青蒿素部分耐药性的认识，重点关注非洲耐药性的出现，包括其流行病学、传播动力学和机制。目前，非洲新出现的耐药性的临床影响尚不清楚，大多数现有证据表明，主要 ACT 的疗效仍然出色，但迫切需要更好地了解问题的严重程度及其对治疗和控制耐药性的影响。疟疾。