Richardus J H, Finlay K M, Croft R P, Smith W C
Leprosy Mission-Bangladesh, Banani, Bangladesh.
Lepr Rev. 1996 Dec;67(4):297-305. doi: 10.5935/0305-7518.19960030.
This retrospective cohort study includes all new leprosy patients registered for multidrug therapy (MDT) in 1990 at the Danish-Bangladesh Leprosy Mission project in Bangladesh. The main objective was to determine the extent of nerve-function impairment (NFI) at diagnosis and at completion of MDT, and to identify opportunities for intervention and their relative impact on the prevention of disabilities (POD). A total of 786 patients were included; 486 males and 300 females. There were 315 PB, and 471 MB patients. In terms of the WHO leprosy disability grading system, at the time of diagnosis 31/315 (9.8%) had grade 1 or grade 2 disability in the PB group, and 177/471 (37.6%) in the MB group. The incidence rate of NFI during MDT was 3.5 per 100 person years at risk (PYR) in the PB group, and 7.5 per 100 PYR in the MB group. In the MB group 37 (7.9%) previously normal patients sustained NFI during MDT, whilst 19 (4.0%) with NFI at diagnosis showed complete recovery at completion of MDT. The most commonly involved nerves were the ulnar (motor function) and the posterior tibial nerves (sensibility). Reversal reactions were observed in 0.6% of the PB patients during MDT, giving an incidence rate of 1 per 100 PYR. The percentage of MB patients diagnosed with reversal during MDT was 14.2%, giving an incidence rate of 6 per 100 PYR. The percentage of MB patients diagnosed with ENL during MDT was 2.1%, with an incidence rate of 1 per 100 PYR. It was concluded that early detection of new cases of leprosy would prevent disabilities in more than 30% of all patients, thus having the highest impact in the quest for the prevention of disabilities. POD activities during and after MDT will prevent disabilities in approximately 10% of all cases. This study also indicates that treatment with prednisolone is effective and should be available at field level for all patients with recent NFI.
这项回顾性队列研究纳入了1990年在孟加拉国丹麦-孟加拉国麻风病防治项目中登记接受多药联合化疗（MDT）的所有新确诊麻风病患者。主要目的是确定诊断时和MDT结束时神经功能损害（NFI）的程度，并确定干预机会及其对预防残疾（POD）的相对影响。共纳入786例患者，其中男性486例，女性300例。有315例结核样型（PB）患者和471例瘤型（MB）患者。根据世界卫生组织麻风病残疾分级系统，诊断时PB组31/315（9.8%）有1级或2级残疾，MB组177/471（37.6%）有1级或2级残疾。MDT期间PB组NFI发病率为每100人年风险（PYR）3.5例，MB组为每100 PYR 7.5例。MB组中，37例（7.9%）之前神经功能正常的患者在MDT期间出现NFI，而诊断时有NFI的19例（4.0%）患者在MDT结束时完全恢复。最常受累的神经是尺神经（运动功能）和胫后神经（感觉功能）。MDT期间，PB组0.6%的患者出现了反应停，发病率为每100 PYR 1例。MDT期间诊断为反应停的MB组患者比例为14.2%，发病率为每100 PYR 6例。MDT期间诊断为麻风结节性红斑（ENL）的MB组患者比例为2.1%，发病率为每100 PYR 1例。研究得出结论，早期发现麻风病新病例可预防超过30%患者的残疾，因此在预防残疾方面影响最大。MDT期间及之后的POD活动可预防约10%病例的残疾。这项研究还表明，泼尼松龙治疗有效，应在现场为所有近期出现NFI的患者提供。
