Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Int J Dermatol. 2018 Sep;57(9):1107-1113. doi: 10.1111/ijd.14041. Epub 2018 May 29.
Various clinical criteria are used to categorize leprosy patients into paucibacillary (PB) and multibacillary (MB), thus aiding in appropriate treatment. However, comprehensive studies validating these criteria are minimal.
To assess sensitivity and specificity of different clinical criteria individually and in combination for classifying leprosy into PB/MB spectrum.
A prospective study was conducted wherein 50 newly diagnosed, untreated leprosy cases were recruited and classified into PB and MB using the following clinical criteria: number of skin lesions (NSL), number of body areas affected (NBAA), and size of largest skin lesion (SLSL). Patients with pure neuritic leprosy, diffuse macular type of lepromatous leprosy, and with reactions were excluded. Sensitivity and specificity of these clinical criteria in classification was calculated taking histopathological findings as gold standard.
Among 50 patients, 37 were males and 13 were females with a mean age of 32.08 ± 16.55 years. The sensitivity and specificity of NSL, NBAA, and SLSL was 94.74 and 87.1%, 94.74 and 61.29%, and 73.68 and 16.13%, respectively. Combining all three criteria, the sensitivity increased to 100%, but specificity decreased drastically to 12.9%. The ROC curve for NSL, NBAA, and SLSL showed a cutoff of ≥6 skin lesions, ≥3 body areas affected, and ≤2 cm lesion to classify as MB.
The current WHO system of leprosy classification based on NSL seems to be best among available clinical criteria. Uniform and sensible application of this criteria itself assures appropriate categorizing and leprosy treatment with reasonable sensitivity and specificity.
各种临床标准被用于将麻风病患者分为少菌型（PB）和多菌型（MB），从而有助于进行适当的治疗。然而，对这些标准进行全面验证的研究很少。
评估单独和联合使用不同临床标准对麻风病进行 PB/MB 分类的敏感性和特异性。
进行了一项前瞻性研究，其中招募了 50 例新诊断、未经治疗的麻风病患者，并使用以下临床标准将其分为 PB 和 MB：皮损数（NSL）、受累体区数（NBAA）和最大皮损面积（SLSL）。排除单纯神经炎型麻风、弥漫性红斑狼疮型麻风以及有反应的患者。以组织病理学发现为金标准，计算这些临床标准在分类中的敏感性和特异性。
在 50 例患者中，男性 37 例，女性 13 例，平均年龄为 32.08±16.55 岁。NSL、NBAA 和 SLSL 的敏感性和特异性分别为 94.74%和 87.1%、94.74%和 61.29%以及 73.68%和 16.13%。联合使用这三个标准，敏感性提高到 100%，但特异性急剧下降到 12.9%。NSL、NBAA 和 SLSL 的 ROC 曲线显示，皮损数≥6、受累体区数≥3 和皮损最大直径≤2cm 可将病例分类为 MB。
目前基于 NSL 的世界卫生组织麻风病分类系统似乎是现有临床标准中最好的。该标准的统一和合理应用本身可确保对患者进行适当的分类和治疗，具有合理的敏感性和特异性。
