Ishida Yutaka
National Suruga Sanatorium, Gotemba-city, Shizuoka, Japan.
Nihon Hansenbyo Gakkai Zasshi. 2009 Sep;78(3):277-82. doi: 10.5025/hansen.78.277.
Prevalence of disability among leprosy patients and effectiveness of standard predonisolone treatment for leprosy reaction at field level in some place of Myanmar are shown in this paper as results of joint leprosy research collaboration. WHO disability grading was measured for all newly registered leprosy patients through 2007 in 5 selected townships of Ayeyarwaddy Division, with the results of G0 = 66.3%, GI = 18.9%, GII = 14.7% (N = 95). The cross-sectional disability survey at selected 9 townships in Mandalay, Sagaing and Magway Division for all registered patients who had completed WHO/MDT done by JICA project in 2003/4 showed G0 = 62.5%, GI = 2.4%, GII = 35.1% (N = 10,528). From these two data, it is supposed that considerable number of patients with G1 at registered time developed worsening of disability from G1 to G2. Proportion of G0 also reduced a little bit in patients who completed WHO/MDT. Early detection and proper treatment of leprosy reaction are one of the main issues of prevention of disability. Effectiveness of leprosy reaction services were evaluated at Mandalay Special Skin Clinic, where WHO fixed regimen of prednisolone were given as routine service. 100 cases were evaluated who developed leprosy reactions from 1st December 2007 to 31st December 2008 and identified severe reaction who needed oral prednisolone treatment. Evaluation criteria of "effective" was defined as "no more signs and symptoms of reactions were present after treatment. And "less effective" was defined as "more than one of signs and symptoms were still remained after treatment". Over all "effective" was 36 (36%) and "less effective" was 64 (64%). It was also found that rates of improvement of nerve functions, either in sensory or in motor, were little after the standard treatment.
本文展示了缅甸某地麻风病患者的残疾患病率以及标准泼尼松龙治疗麻风反应在现场层面的有效性,这些是麻风病联合研究合作的成果。通过对伊洛瓦底省5个选定镇区2007年新登记的所有麻风病患者进行世界卫生组织残疾分级测量,结果显示G0 = 66.3%,G1 = 18.9%,GII = 14.7%(N = 95)。对2003/4年日本国际协力机构项目完成世界卫生组织/多药联合化疗的曼德勒、实皆和马圭省9个选定镇区的所有登记患者进行的横断面残疾调查显示,G0 = 62.5%,G1 = 2.4%,GII = 35.1%(N = 10,528)。从这两组数据推测,相当数量登记时为G1级的患者残疾状况从G1恶化到了G2。完成世界卫生组织/多药联合化疗的患者中G0的比例也略有下降。麻风反应的早期检测和适当治疗是预防残疾的主要问题之一。在曼德勒特殊皮肤病诊所对麻风反应服务的有效性进行了评估,该诊所按世界卫生组织规定的泼尼松龙方案提供常规服务。对2007年12月1日至2008年12月31日出现麻风反应且被确定为需要口服泼尼松龙治疗的严重反应患者中的100例进行了评估。“有效”的评估标准定义为“治疗后不再有反应的体征和症状”,“效果较差”定义为“治疗后仍有不止一种体征和症状”。总体而言,“有效”的有36例(36%),“效果较差”的有64例(64%)。还发现,标准治疗后感觉或运动神经功能的改善率都很低。