Jiang J, Watson J M, Zhang G C, Wei X Y
Institute of Dermatology, Chinese Academy of Medical Sciences, Nanjing, People's Republic of China.
Lepr Rev. 1998 Dec;69(4):367-75. doi: 10.5935/0305-7518.19980037.
As part of a collaborative project between the Ministry of Health of China (MOH) and The Leprosy Mission International (TLMI) on leprosy rehabilitation and prevention of disability (POD), a total of 1407 patients was monitored for possible nerve function impairment (NFI) through standardized clinical nerve function assessment between May 1995 and February 1998. Of these, 191 patients were found to have NFI and were put on a fixed regimen of prednisolone. In this study, 36.7% of NFI occurred before diagnosis of leprosy, 35.6% developed during MDT and 25.7% after their release from MDT. Overall, 7.5% (105 out of 1407) of all patients, or 55.9% of patients with NFI, suffered from silent neuropathy. Of the affected nerves, 62.6% had silent neuropathy. Sensory impairment responded to prednisolone satisfactorily, giving a recovery rate of 73.8%, 76.5% and 81.0% in ulnar, median and posterior tibial nerve, respectively. Sensibility in patients even with a NFI duration longer than 6 months made significant improvement (p < 0.05). Motor function improvement was less satisfactory, especially in ulnar and c. popliteal nerve. The possible reasons are analysed. Our findings with regard to sensibility changes confirm that once it becomes clinically detectable, NFI is no longer at the 'early' stage. More sensitive tests are necessary to detect real 'early' sensory impairment in the field. Our study also indicates that with well-trained field staff and proper equipment for nerve function assessment, early detection and treatment of NFI can be practical and effective.
作为中国卫生部（MOH）与国际麻风病防治协会（TLMI）关于麻风病康复与残疾预防（POD）合作项目的一部分，在1995年5月至1998年2月期间，通过标准化临床神经功能评估对总共1407例患者进行了可能的神经功能损害（NFI）监测。其中，191例患者被发现有NFI，并接受了泼尼松龙固定疗程治疗。在本研究中，36.7%的NFI发生在麻风病诊断之前，35.6%在多药联合化疗（MDT）期间出现，25.7%在MDT结束后出现。总体而言，所有患者中有7.5%（1407例中的105例），即NFI患者的55.9%，患有无症状性神经病变。在受影响的神经中，62.6%有无症状性神经病变。感觉障碍对泼尼松龙反应良好，尺神经、正中神经和胫后神经的恢复率分别为73.8%、76.5%和81.0%。即使NFI持续时间超过6个月的患者，其感觉也有显著改善（p<0.05）。运动功能改善不太理想，尤其是尺神经和腘神经。分析了可能的原因。我们关于感觉变化的研究结果证实，一旦临床上可检测到，NFI就不再处于“早期”阶段。在该领域需要更敏感的检测方法来检测真正的“早期”感觉障碍。我们的研究还表明，有训练有素的现场工作人员和适当的神经功能评估设备，NFI的早期检测和治疗是切实可行且有效的。
