van Brakel W H, Reed N K, Reed D S
INF Leprosy Project, Pokhara, Nepal.
Lepr Rev. 1999 Jun;70(2):180-8. doi: 10.5935/0305-7518.19990021.
The aim of the paper is to discuss the concept of 'severity grading' in relation to impairment in leprosy, and to describe the use of an impairment sum score, the Eyes, Hands, Feet (EHF) score, as an indicator of the severity and the evolution of impairment over time. The use of an impairment sum score, the EHF score, is illustrated using data on impairment at diagnosis and after a 2-year interval from MB patients released from MDT in the Western Region of Nepal. The WHO 1988 'disability' grading scale (0-2, for both eyes, hands and feet--six sites) was used as a measure of impairment. For the analysis, the WHO grades for the six sites were summed to form an EHF score (minimum 0, maximum 12). The sensitivity to change over time of the EHF score was compared with that of the 'method of maximum grades'. Using the 'method of maximum grades', 509/706 patients (72%) appeared not to have changed in impairment status, compared with only 399 (56.5%) with the EHF score. Improvement or deterioration of impairment status was missed in 113 patients (16%). In 216/706 patients (30.6%), the changes detected with the EHF score were bigger than those revealed by the method of maximum grades. The six components of the WHO impairment grading may be added up to form a EHF sum score of impairment. This score can be used to monitor changes in impairment status in individuals or in groups. It should be recorded and reported at least at diagnosis and release from treatment. Reporting could be done as the 'proportion of patients with improved EHF score', 'stable EHF score' and 'EHF score worse', and 'proportion of patients without impairment', 'proportion with WHO grade 1' and 'proportion with WHO grade 2'. It is recommended that the concepts and terminology of the WHO International Classification of Impairments, Activities and Participation (ICIDH-2) be adopted in the field of leprosy, particularly for the areas of prevention of impairment and disability and rehabilitation. The 'WHO disability grade' should be renamed 'WHO impairment grade'.
本文旨在探讨麻风病损伤方面的“严重程度分级”概念，并描述一种损伤总和评分——眼、手、足（EHF）评分作为损伤严重程度及随时间演变的指标的应用。利用尼泊尔西部地区接受多药联合化疗（MDT）后释放的瘤型麻风（MB）患者诊断时及两年后的损伤数据，阐述了EHF评分这一损伤总和评分的应用。采用世界卫生组织1988年的“残疾”分级量表（双眼、双手和双足共六个部位，分级为0 - 2级）作为损伤衡量标准。分析时，将六个部位的世界卫生组织分级相加得出EHF评分（最小值为0，最大值为12）。将EHF评分随时间变化的敏感性与“最高分级法”的敏感性进行比较。采用“最高分级法”时，706例患者中有509例（72%）损伤状况似乎未发生变化，而采用EHF评分时，仅有399例（56.5%）。113例患者（16%）的损伤状况改善或恶化被漏判。在706例患者中有216例（30.6%），EHF评分检测到的变化大于最高分级法所显示的变化。世界卫生组织损伤分级的六个组成部分可相加形成EHF损伤总和评分。该评分可用于监测个体或群体损伤状况的变化。至少应在诊断时和治疗结束时进行记录和报告。报告可采用“EHF评分改善患者的比例”“EHF评分稳定”“EHF评分恶化”，以及“无损伤患者的比例”“世界卫生组织1级比例”和“世界卫生组织2级比例”等形式。建议在麻风病领域采用世界卫生组织《国际损伤、活动与参与分类》（ICIDH - 2）的概念和术语，特别是在预防损伤和残疾以及康复方面。“世界卫生组织残疾分级”应更名为“世界卫生组织损伤分级”。
