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麻风病中的周围神经病变:哥伦比亚国家转诊中心的临床表现与残疾情况

Peripheral neuropathy in leprosy: Clinical manifestations and disability in a Colombian national referral center.

作者信息

Trujillo-Ramirez Laura, Palacios-Ariza María Alejandra, Pradilla Ivan, Gamboa Luis Arturo

机构信息

Faculty of Medicine, Fundación Universitaria Sanitas, Bogotá.

Research Unit, Fundación Universitaria Sanitas, Bogotá.

出版信息

Dermatol Reports. 2021 Aug 5;14(2):9308. doi: 10.4081/dr.2021.9308. eCollection 2022 Jun 16.

DOI:10.4081/dr.2021.9308
PMID:35832264
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9272011/
Abstract

To aim of the paper was to describe the neurological features of the physical examination in patients with Hansen's disease who were treated in Bogotá, Colombia. We carried out a descriptive study of all patients with a Hansen's disease diagnosis treated at a referral center between 2003-2018. There were 327 eligible electronic health records (EHRs) with a final sample of 282 subjects. Leprosy was most common in males (57.45%), median age at the diagnosis was 54 years, and lesions of the lower limbs were more common (75.1%). The median time from disease onset to consult was 12 months. Most of them were classified as having lepromatous leprosy (39.7%). Pain over the median nerve trunk was the most common manifestation of disease (28%), followed by pain over the radial trunk (22%). Sensitive alterations were more common than motor ones. Specifically, the posterior tibial nerve was affected in nearly half of subjects. Dual impairment was more common in the ulnar nerve (13.8%). Some disability was apparent in 23.8% of subjects; predominantly grade 1 disability. Findings regarding age, leprosy type, and the frequency of individual nerve compromise were consistent with reports from other countries. Nerve trunk thickening was infrequent, which might be a consequence of subjectiveness in the examination and sample differences in sex distribution, degree of disability and time since disease onset. The frequency of morbidity and disability found in this sample, though low when compared with other series, fails to meet public health goals, including those limiting disability in younger subjects.

摘要

本文旨在描述在哥伦比亚波哥大接受治疗的麻风病患者体格检查的神经学特征。我们对2003年至2018年期间在一家转诊中心接受治疗的所有确诊为麻风病的患者进行了描述性研究。共有327份符合条件的电子健康记录(EHR),最终样本为282名受试者。麻风病在男性中最为常见(57.45%),诊断时的中位年龄为54岁,下肢病变更为常见(75.1%)。从疾病发作到就诊的中位时间为12个月。其中大多数被归类为瘤型麻风(39.7%)。正中神经干疼痛是最常见的疾病表现(28%),其次是桡神经干疼痛(22%)。感觉改变比运动改变更为常见。具体而言,近一半的受试者胫后神经受到影响。尺神经双功能障碍更为常见(13.8%)。23.8%的受试者存在明显残疾;主要为1级残疾。关于年龄、麻风病类型和个别神经受损频率的研究结果与其他国家的报告一致。神经干增粗并不常见,这可能是检查主观性以及性别分布、残疾程度和疾病发作时间样本差异的结果。与其他系列相比,本样本中发现的发病率和残疾率较低,但仍未达到公共卫生目标,包括那些限制年轻受试者残疾的目标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef7/9272011/4f1efe968ffc/dr-14-2-9308-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef7/9272011/4aa5a24cbd6b/dr-14-2-9308-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef7/9272011/4f1efe968ffc/dr-14-2-9308-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef7/9272011/4aa5a24cbd6b/dr-14-2-9308-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eef7/9272011/4f1efe968ffc/dr-14-2-9308-g002.jpg

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Risk Factors for Physical Disability in Patients With Leprosy: A Systematic Review and Meta-analysis.麻风病患者身体残疾的危险因素:系统评价与荟萃分析
JAMA Dermatol. 2019 Oct 1;155(10):1120-1128. doi: 10.1001/jamadermatol.2019.1768.
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Assessment of the sensory and physical limitations imposed by leprosy in a Brazilian Amazon Population.对巴西亚马逊地区人群中麻风病所造成的感觉和身体限制的评估。
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