Van Brakel W H, Khawas I B
Green Pastures Hospital, Pokhara, Nepal.
Lepr Rev. 1994 Sep;65(3):204-21. doi: 10.5935/0305-7518.19940020.
A historic cohort study was performed to determine the prevalence and incidence rates of nerve function impairment (NFI) as demonstrated by sensory testing with a nylon monofilament and standard tests of motor function. The records of 396 new leprosy patients registering at Green Pastures Hospital, Pokhara, between January 1988 and January 1992 were analysed. The mean follow-up period was 21 months. In all, 36% (141/396) of patients had either sensory or motor function impairment at their initial examination. For each nerve the prevalence of sensory and motor impairment is reported separately. The posterior tibial nerve was the most frequently affected (sensory) nerve (21%). Sensory impairment of the ulnar nerve was found in 17% of the patients; 8.8% had sensory impairment of the median nerve. The overall incidence rate of motor function impairment was 7.5 (5.4-10) per 100 person years at risk (PYAR). Sensory impairment had a significantly higher rate of 13 (10-17)/100 PYAR (rate ratio (1.8 (1.2-2.7), p = 0.0076). Bl patients had a significantly higher incidence rate of nerve function impairment than BT patients (rate ratio 2.3 (1.4-3.7), p = 0.006). Altogether 152/396 (39%) of the patients required corticosteroid treatment for 'recent' or 'acquired' impairment, and 78 of the patients (20%) developed severe nerve function impairment during or after antileprosy treatment. Analysis of potential risk factors for nerve function impairment showed a significant association with the extent of clinical disease expressed as the number of body areas (out of 9) with primary or secondary signs of leprosy (rate ratio 5.0 (1.5-17), p = 0.0091). It was concluded that nerve function impairment is a serious problem, often occurring during or after multidrug therapy. The extent of clinical disease expressed as a count of body areas involved, or of skin or nerve lesions may identify patients who are at increased risk of nerve damage.
开展了一项历史性队列研究，以确定通过尼龙单丝感觉测试和运动功能标准测试所显示的神经功能损害（NFI）的患病率和发病率。分析了1988年1月至1992年1月在博卡拉绿草地医院登记的396例新麻风病患者的记录。平均随访期为21个月。总共有36%（141/396）的患者在初次检查时存在感觉或运动功能损害。对于每条神经，分别报告感觉和运动损害的患病率。胫后神经是最常受影响（感觉）的神经（21%）。17%的患者存在尺神经感觉损害；8.8%的患者存在正中神经感觉损害。运动功能损害的总发病率为每100人年风险（PYAR）7.5（5.4 - 10）。感觉损害的发病率显著更高，为每100 PYAR 13（10 - 17）（率比（1.8（1.2 - 2.7），p = 0.0076）。BL患者的神经功能损害发病率显著高于BT患者（率比2.3（1.4 - 3.7），p = 0.006）。共有152/396（39%）的患者因“近期”或“获得性”损害需要接受皮质类固醇治疗，78例患者（20%）在抗麻风病治疗期间或之后出现严重神经功能损害。对神经功能损害潜在危险因素的分析显示，与以麻风病原发或继发体征的身体部位数量（共9个）表示的临床疾病程度存在显著关联（率比5.0（1.5 - 17），p = 0.0091）。研究得出结论，神经功能损害是一个严重问题，常在多药治疗期间或之后出现。以受累身体部位数量或皮肤或神经病变数量表示的临床疾病程度，可能识别出神经损伤风险增加的患者。
