Feuth M, Brandsma J Wim, Faber W R, Bhattarai B, Feuth T, Anderson A M
Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
Lepr Rev. 2008 Sep;79(3):254-69.
Erythema nodosum leprosum (ENL) is an inflammatory reaction, which may occur in the course of leprosy and may result in nerve function impairment and subsequent disability.
This retrospective study explores demographic and disease specific parameters. Severity of ENL was assessed using the Reaction Severity Scale (RSS). Records of 94 patients were reviewed. The study reports also on the treatment of 76 of these patients who were treated with prednisolone alone or thalidomide in addition to prednisolone. RESULTS Thirty percent of patients presented with ENL at time of diagnosis; 41% developed ENL-reaction in the first year of MDT. Forty-eight percent of patients were treated for ENL-reaction for less than 12 months; 13% for more than 5 years. High RSS-scores correlated with a longer duration of treatment. In group A (prednisolone) 51.7% and in group B (prednisolone and thalidomide) 76.6% of patients were male. Age, leprosy classification, delay of multidrug treatment (MDT) and interval between MDT and first ENL-symptoms did not differ significantly in both groups. Median duration of ENL-treatment was 15 months in group A versus 38 months in group B (P < 0.001). At the start of treatment, ENL-reaction was less severe in group A (RSS = 12) than in group B (RSS = 18; P = 0.003).
ENL-symptoms may be of help in the early diagnosis and adequate treatment of ENL. Characterisation of (sub) groups of patients with ENL based on presence and severity of symptoms is important for future prospective studies to better evaluate the efficacy of interventions.
结节性红斑型麻风反应（ENL）是一种炎症反应，可能发生在麻风病程中，并可能导致神经功能损害及随后的残疾。
本回顾性研究探讨了人口统计学和疾病特定参数。使用反应严重程度量表（RSS）评估ENL的严重程度。回顾了94例患者的记录。该研究还报告了其中76例患者的治疗情况，这些患者单独接受泼尼松龙治疗或除泼尼松龙外还接受沙利度胺治疗。结果30%的患者在诊断时出现ENL；41%的患者在多药联合治疗（MDT）的第一年出现ENL反应。48%的患者接受ENL反应治疗的时间少于12个月；13%的患者接受治疗超过5年。高RSS评分与较长的治疗持续时间相关。A组（泼尼松龙）51.7%的患者和B组（泼尼松龙和沙利度胺）76.6%的患者为男性。两组患者的年龄、麻风分类、多药治疗（MDT）延迟以及MDT与首次ENL症状之间的间隔无显著差异。A组ENL治疗的中位持续时间为15个月，而B组为38个月（P < 0.001）。治疗开始时，A组的ENL反应（RSS = 12）比B组（RSS = 18；P = 0.003）轻。
ENL症状可能有助于ENL的早期诊断和充分治疗。根据症状的存在和严重程度对ENL患者（亚）组进行特征描述，对于未来的前瞻性研究更好地评估干预措施的疗效很重要。
