Reed N K, van Brakel W H, Reed D S
Physiotherapist, Green Pastures Hospital, Pokhara, Nepal.
Int J Lepr Other Mycobact Dis. 1997 Sep;65(3):328-36.
To investigate the progress of impairment over time in multibacillary (MB) leprosy patients.
Retrospective cohort study.
One-thousand-eighty-two MB patients newly registered in nine field clinics in the Western Region of Nepal between 1980 and 1993.
Data on impairment at diagnosis and at yearly intervals afterward were collected from patient records of MB patients already released from multidrug therapy (MDT). The World Health Organization (WHO) 1988 "disability" grading scale (0-2, for both eyes, hands and feet--six sites) was used as a measure of impairment. For the analysis we summed the WHO grading for the six sites into an eyes-hands-feet (EHF) sum score (minimum 0, maximum 12). The EHF score at 2 years of follow up was used to compute the main outcome measures: impairment at 2 years, yes or no, and deterioration of impairment compared with diagnosis. The combined effect of age, sex, classification and impairment status at diagnosis on the outcome was examined with logistic regression.
At diagnosis, 55.8% of the patients had some impairment. This proportion decreased over 2 years to 43.9%. Among patients without initial impairment, 31/310 (10%) developed impairment during the study period. This was 81/396 (20.5%) among patients with impairment at diagnosis. The adjusted odds ratio (OR) for developing impairment was 1.87 [95% confidence interval (CI) 1.06-3.32] for patients with initial sensory impairment (WHO grade 1). and 1.98 (95% CI 1.15-3.4) for those with initial visible deformity (WHO grade 2). Among patients with impairment at diagnosis, 195/396 (49.2%) had improved after 2 years.
The proportion of patients with impairment after 2 years of antileprosy treatment was 12% less than at diagnosis. Among patients without initial impairment, 10% had developed some impairment after 2 years. The risk of developing impairment was almost double for those with sensory impairment or visible deformity at diagnosis. For purposes of monitoring, evaluation and planning, both the proportion of patients with sensory impairment (WHO grade 1) and the proportion with visible deformity (WHO grade 2) should be reported at diagnosis and at release from treatment.
调查多菌型（MB）麻风病患者随时间推移的残疾进展情况。
回顾性队列研究。
1980年至1993年间在尼泊尔西部地区9个现场诊所新登记的1082例MB患者。
从已完成多药联合化疗（MDT）的MB患者的病历中收集诊断时及之后每年的残疾数据。采用世界卫生组织（WHO）1988年的“残疾”分级量表（双眼、双手和双脚共6个部位，分级为0 - 2级）来衡量残疾情况。分析时，我们将6个部位的WHO分级汇总为眼 - 手 - 足（EHF）总分（最低0分，最高12分）。随访2年时的EHF评分用于计算主要结局指标：2年时是否存在残疾，以及与诊断时相比残疾是否恶化。采用逻辑回归分析年龄、性别、分类及诊断时的残疾状态对结局的综合影响。
诊断时，55.8%的患者存在某种残疾。该比例在2年内降至43.9%。在初始无残疾的患者中，310例中有31例（10%）在研究期间出现了残疾。诊断时已有残疾的患者中，这一比例为396例中的81例（20.5%）。初始有感觉障碍（WHO 1级）的患者出现残疾的调整优势比（OR）为1.87 [95%置信区间（CI）1.06 - 3.32]，初始有可见畸形（WHO 2级）的患者为1.98（95% CI 1.15 - 3.4）。诊断时已有残疾的患者中，396例中有第195例（49.2%）在2年后有所改善。
抗麻风治疗2年后有残疾的患者比例比诊断时低12%。初始无残疾的患者中，10%在2年后出现了某种残疾。诊断时有感觉障碍或可见畸形的患者出现残疾的风险几乎翻倍。为了进行监测、评估和规划，应报告诊断时及治疗结束时感觉障碍（WHO 1级）患者比例和可见畸形（WHO 2级）患者比例。
