Nadkarni N J, Grugni A, Kini M S
Int J Lepr Other Mycobact Dis. 1993 Mar;61(1):25-8.
We analyzed the records of 1022 patients of paucibacillary leprosy who had received either 6 doses of WHO-MDT alone (" classical" MDT, 668 patients) or had post-MDT dapsone for at least 6 months ("modified" MDT, 354 patients). The duration of posttherapy surveillance ranged from 6 months to 7 years (mean 20.4 months). We found that the incidence of unfavorable events was significantly higher with the classical regimen when patients were graded as active at the end of the fixed duration regimen, especially when patients with > 2 lesions were considered. In the patients who were graded as inactive at the end of 6 doses, there was a slight excess of unfavorable events in the modified regimen, although not statistically significant. No correlation was found between unfavorable events and the regularity of treatment or the lepromin status. Overall, the incidence of adverse events was higher in patients with multiple lesions, and more than 90% of the adverse events occurred during the first 2 years of follow up. It is felt that 6 doses of MDT is adequate in the majority of patients who have few lesions or who have become inactive at the end of the treatment period. However, caution should be exercised in those with multiple lesions or in those considered active at the end of 6 doses.
我们分析了1022例少菌型麻风患者的记录，这些患者要么仅接受了6剂世界卫生组织多药联合化疗（“经典”多药联合化疗，668例患者），要么在多药联合化疗后服用氨苯砜至少6个月（“改良”多药联合化疗，354例患者）。治疗后监测的持续时间为6个月至7年（平均20.4个月）。我们发现，当患者在固定疗程结束时被评定为活动性时，尤其是考虑有超过2处皮损的患者时，经典方案的不良事件发生率显著更高。在6剂治疗结束时被评定为非活动性的患者中，改良方案的不良事件略多一些，尽管无统计学意义。未发现不良事件与治疗规律或麻风菌素状态之间存在相关性。总体而言，有多处皮损的患者不良事件发生率更高，且超过90%的不良事件发生在随访的前2年。认为对于大多数皮损少或在治疗期结束时已转为非活动性的患者，6剂多药联合化疗是足够的。然而，对于有多处皮损的患者或在6剂治疗结束时被认为是活动性的患者，应谨慎对待。
