Sharma P, Kar H K, Beena K R, Kaur H, Narayan R
Department of Dermatology, STD and Leprosy; Dr Ram Manohar Lohia Hospital, New Delhi.
Indian J Lepr. 1996 Apr-Jun;68(2):127-36.
One hundred fifty-one patients (125 males and 26 females) of multibacillary leprosy (LL 88, BL 40, BB 23), registered during 1986-1992 for multidrug therapy (MDT), were analysed with reference to their disabilities before, during and after MDT. At induction 48 (31.7%) had no disability (Gr 0), 59 (39.0%) had only peripheral anaesthesia (Gr 1) and 44 (29.1%) had Gr 2 and 3 deformities with or without anaesthesia. The parallel analysis of the three groups, with nearly equal duration of symptoms, revealed that new deformities developed in only a few cases during and after MDT, least in the Gr 0 group. The crude fresh deformity incidence was 59.2 per 1,000 person years of observation. The rate of recovery from anaesthesia was higher (64%) in Gr 1 group than that (44%) in group with Gr 2, 3 deformities. No significant difference was observed between the incidence of Gr 2 deformities developed before, during and after MDT (incidence of claw-hands 9.2% before and 7.9% during and after MDT, trophic ulcers 13.9% before and 17.8% during and after MDT). Out of 19 cases which developed motor weakness during MDT and follow-up, 10 (52.6%) were instances of quite nerve paralysis. Occupational factors influenced the development of deformities but not the sex and bacterial load. Generally, the lower the Grade of disability at induction of patient for MDT, the lower the chances of new disability development and higher the chances of recovery from sensory impairments.
1986年至1992年期间登记接受多药联合化疗（MDT）的151例多菌型麻风患者（125例男性和26例女性，其中瘤型麻风88例、界线类偏瘤型麻风40例、中间界线类麻风23例），就其在MDT治疗前、治疗期间及治疗后的残疾情况进行了分析。在开始治疗时，48例（31.7%）无残疾（0级），59例（39.0%）仅有周围神经麻木（1级），44例（29.1%）有2级和3级畸形，伴有或不伴有神经麻木。对症状持续时间几乎相同的三组进行的平行分析显示，在MDT治疗期间及治疗后，仅有少数病例出现新的畸形，0级组最少。粗新发畸形发病率为每1000人年观察期59.2例。1级组神经麻木恢复率（64%）高于有2级、3级畸形组（44%）。MDT治疗前、治疗期间及治疗后发生2级畸形的发生率无显著差异（爪形手发生率治疗前为9.2%，治疗期间及治疗后为7.9%；营养性溃疡发生率治疗前为13.9%，治疗期间及治疗后为17.8%）。在MDT治疗及随访期间出现运动功能减弱的19例患者中，10例（52.6%）为完全性神经麻痹。职业因素影响畸形的发生，但性别和细菌载量不影响。一般来说，患者开始接受MDT治疗时的残疾等级越低，出现新残疾的可能性越小，感觉障碍恢复的可能性越大。
