Bhatia A S, Katoch K, Narayanan R B, Ramu G, Mukherjee A, Lavania R K
Central JALMA Institute for Leprosy, Taj Ganj, Agra, India.
Int J Lepr Other Mycobact Dis. 1993 Sep;61(3):433-8.
This study reports our observations on the correlation between clinical and histopathological diagnoses of the classification of leprosy. The histopathological classification of leprosy in 1351 cases was done per Ridley-Jopling criteria and was compared with the clinical diagnoses of the same cases. These 1351 cases included 79 cases diagnosed clinically as having a "reaction." However, the histopathologists could not detect any evidence of reaction in 16 of these 79 cases (20%). Of the remaining 1272 cases, 68 (5%) were reported as "no evidence of leprosy" by the histopathologists; 37 of these 68 were found to be from the clinically indeterminate type of leprosy. Histopathological and clinical diagnoses of the classification of leprosy coincided in 69% of the cases. Concordance between the clinical and histopathological diagnoses for different types of leprosy was: indeterminate (I) = 36%, tuberculoid (TT) = 50%, borderline tuberculoid (BT) = 77%, borderline (BB) = 26%, borderline lepromatous (BL) = 43%, and lepromatous (LL) = 91%. When some of the types were combined (BT with TT, BL with LL), the overall concordance figure was 76%; concordance for the TT/BT group was 80%, for the BL/LL group it was 93%. Since both TT and BT are considered paucibacillary and LL or BL are considered multibacillary for treatment purposes, differentiating TT from BT or BL from LL is, perhaps, therapeutically irrelevant. However, for classification purposes it appears that the weight given to different signs and/or histopathological parameters for classifying leprosy cases (especially TT, BB and I) needs to be reassessed.
本研究报告了我们对麻风病分类的临床诊断与组织病理学诊断之间相关性的观察结果。根据里德利 - 乔普林标准对1351例麻风病患者进行了组织病理学分类，并与这些病例的临床诊断结果进行了比较。这1351例病例中，有79例临床诊断为“有反应”。然而，在这79例病例中，有16例（20%）组织病理学家未发现任何反应迹象。在其余1272例病例中，组织病理学家报告68例（5%）“无麻风病证据”；这68例中有37例来自临床未定类麻风病。麻风病分类的组织病理学诊断与临床诊断在69%的病例中一致。不同类型麻风病的临床诊断与组织病理学诊断的一致性为：未定类（I）=36%，结核样型（TT）=50%，界线结核样型（BT）=77%，界线类（BB）=26%，界线偏瘤型（BL）=43%，瘤型（LL）=91%。当将某些类型合并（BT与TT合并，BL与LL合并）时，总体一致性数字为76%；TT/BT组的一致性为80%，BL/LL组为93%。由于从治疗目的考虑，TT和BT都被视为少菌型，而LL或BL被视为多菌型，因此区分TT与BT或BL与LL在治疗上可能无关紧要。然而，就分类目的而言，似乎需要重新评估在对麻风病病例（尤其是TT、BB和I型）进行分类时给予不同体征和/或组织病理学参数的权重。
