van Brakel W H, Khawas I B
Green Pastures Hospital, Pokhara, Nepal.
Lepr Rev. 1996 Jun;67(2):104-18. doi: 10.5935/0305-7518.19960011.
This retrospective cohort study aimed to determine the progress of sensory and motor function during and after steroid treatment, and to identify any prognostic factors for the outcome of treatment. The study used one hundred and sixty-eight leprosy patients registered at Green Pastures Hospital, Pokhara, West Nepal, who were treated with one of four different corticosteroid regimens for impairment of nerve function. The function of the main peripheral nerve trunks affected in leprosy was assessed with a nylon filament to test touch thresholds (TST) and a manual voluntary muscle test (VMT) to quantify muscle strength. The TST and VMT scores at 3 months after initiation of steroid treatment served as the main outcome measure. The significance of potential prognostic factors was evaluated with logistic regression. At 3 months, the sensory and motor function of the majority of patients with 'recent' impairment ( = less than 6 months duration) had improved significantly (p < 0.01, Wilcoxon matched pairs signed-ranks test). The likelihood of 'good' recovery (prognosis) for both sensibility and motor function was directly related to the severity of the nerve damage at the beginning of treatment. Although nerve function improved in 30-84% (depending on the type of nerve) of patients, an active search for better methods of treatment and improved regimens is justified. The need for early assessment and treatment is stressed.
这项回顾性队列研究旨在确定类固醇治疗期间及之后感觉和运动功能的进展情况，并确定治疗结果的任何预后因素。该研究选取了尼泊尔西部博卡拉绿草地医院登记的168例麻风病患者，他们因神经功能受损接受了四种不同皮质类固醇治疗方案中的一种。使用尼龙丝测试触觉阈值（TST）和手动随意肌测试（VMT）来评估麻风病中受影响的主要外周神经干的功能，以量化肌肉力量。类固醇治疗开始3个月时的TST和VMT分数作为主要结局指标。使用逻辑回归评估潜在预后因素的显著性。在3个月时，大多数“近期”受损（病程小于6个月）患者的感觉和运动功能有显著改善（p < 0.01，Wilcoxon配对符号秩检验）。感觉和运动功能“良好”恢复（预后）的可能性与治疗开始时神经损伤的严重程度直接相关。尽管30%至84%（取决于神经类型）的患者神经功能有所改善，但积极寻找更好的治疗方法和改进治疗方案是合理的。强调了早期评估和治疗的必要性。
