麻风腓总神经及其分支损害的回顾性研究

麻风好侵犯腓总神经及其分支 ,导致感觉障碍 ,肌肉瘫痪等畸残 ,为了解腓总神经及其分支的受累情况 ,1997年至1999年间 ,我们对 2 75例麻风治愈病人进行了腓总神经及其分支损害的专项调查 ,现将有关资料分析如下 :1　材料和方法1 1　一般资料　对随机抽取的 4个乡镇和住院部的所有麻风病人以及处于ＭＤＴ监测期病人进行调查 ,计 2 75例 ,其中男199例 ,女 76例 ;型别ＬＬ 5 4例 ,ＢＬ 2 8例 ,ＢＢ 18例 ,ＢＴ 32例 ,ＴＴ 143例 ;年龄 18～ 92岁 ,平均 6 0 34± 12 0 6岁 ;麻风病期 1～ 5 0年 ,平均 7 86± 0 5 3年 ;住院病人 6 3例 ,院外病…     

麻风溃疡的综合防治

足底溃疡是麻风常见的并发症和后遗症,是导致畸残的主要原因之一;麻风由于胫后神经受损,感觉丧失,血运障碍及出汗减少,故容易形成足底溃疡,其发生率约为30％,有的麻风院内为51.3％,在家的为19.84％。由于麻风病人患肢的胫后神经受侵而足底     

麻风患者尺神经及其功能分支损害的临床研究

为研究麻风患者尺神经及其功能分支受损情况，对84例麻风患者尺神经及其功能分支受损情况进行现场调查，根据各分支管理区域感觉及支配肌肉肌力情况判断受累情况。84例麻风患者中有35例尺神经损害，占41．67％，尺神经受累患者平均3．74条分支受累，尺神经分支中以尺神经深支（23．21％）及其感觉支第4指间皮支（19．64％）最为常见受损，其次为小指尺侧皮支（16．67％）受累也很常见，腕背支（14．29％）相对受损稍少，前臂肌支（4．17％）受侵最少见。受侵的表现以感觉支和运动支同时出现障碍最多见，占71．43％（25／35）。结论：（1）麻风尺神经及其分支受累相当普遍，全面掌握其临床表现对于麻风早期发现意义重大；（2）麻风尺神经受累以分支型损害为主，低位的分支较易受累；（3）新发现患者高受累率及感觉支运动支绝大多数同时障碍，说明麻风早期发现工作仍有待改进提高，建议重视包括腕背支感觉的相关检查从而早期发现神经受累的存在，避免出现神经功能的更严重受损。     

234例麻木足使用防护鞋28个月效果观察

麻风胫后神经损伤引起足底麻木 ,是造成足底溃疡和继发性畸残的重要原因。足底溃疡也是麻风患者常见的并发症、后遗症。长期以来 ,防治足底溃疡是防治工作中的难题。目前应用防护鞋旨在解决足底的受力问题 ,是防治足底溃疡的一项重要措施。我们从 1995年 7月～ 1998年2月 ,在文山、大理、洱源 3个县开展了麻风防护鞋的使用效果观察 ,结果如下 :穿鞋对象选择 :( 1)年龄在 6 5周岁以下 ,能参加一般劳动和生活能力自理者 ;( 2 )单足感觉障碍达到 2个点及其以上者 ;( 3)能积极配合做自我护理者。选择了 2 34例病人 ,其中男 16 5例 ,女 6 9例 (表…     

西尼泊尔396例麻风的神经损害

对西尼泊尔一麻风院内资料完整的病例做体表受侵部位计数(全身划为9个部位)。凡肌力测定(VMT)恶化≥2点,感觉试验(TST)恶化≥2点,均为神经功能残损(NFI),6个月以内的为“新发”;VMT记为0～5;TST用单尼龙丝10g(测胫后神经用75g),有感觉记2,可疑记1,无感觉记为0;尺、正中及胫后神经分别测3、4及10个点。396个新病例,平均41岁(2～88),男277;随访335例(1～49个月,平均21个月);MDT256例,单疗71     

麻风病

20 0 5 0 0 91　湖北省麻风流行病学分析 /叶建君 (湖北省疾控中心 )…∥中国麻风皮肤病杂志 . 2 0 0 4,2 0 (2 ) . 1 5 1～ 1 5 2分析后发现 ,全省 80个县 (市 )均发现过麻风病人 ,尤以荆州、武汉和恩施为多 ,占病人总数 75 %以上 ,年平均发病率由最高年段 1 95 5～ 1 95 9年的1 .95 / 1 0万 ,降至 1 995～ 1 999年的 0 0 2 / 1 0万 ;患病率由 1 966年的 0 .1 3‰ ,降至 1 999年底的 0 .0 0 2‰ ,流行范围由 5 479个自然村 ,减少至 1 1 2个自然村。说明湖北省麻风病流行呈持续下降的趋势 ,控制成效显著。参 4　 (张江安 )2 0 0 5 0 0 92　…     

麻风无痛性神经炎早期发现的研究

目的 :　了解麻风无痛性神经炎在各型及实施MDT治疗的不同时期的发生情况。方法 :　定时测试周围神经的感觉和运动功能 ,前后对照 ,以发现早期无痛性神经炎。结果 :　观察 4 5 6例MDT治疗期 ,监测期及解除监测期患者 ,发现无痛性神经炎 4 8例 ,累计检出率 10 .5 3%。治疗期患者的发生率明显高于监测期及解除监测期患者 (P <0 .0 1) ,尺神经和胫神经检出率明显高于其它神经 (P <0 .0 1)。结论 :定期检测周围神经功能 ,早期发现无痛性神经炎十分重要     

S-100蛋白染色在鉴别麻风和其它皮肤肉芽肿疾病中的作用

研究包括 2 5例临床确诊的结核样型麻风患者 (ＴＴ 9例 ,ＢＴ 1 6例 ) ,有皮肤感觉丧失的浅色斑或红斑或斑块 ,皮肤涂片查菌均阴性。其中 8例伴Ⅰ型反应。另有 1 5例经临床和 (或 )病理诊断的非麻风肉芽肿性皮肤病 (皮肤结核9例 ,结节病 1例 ,不明原因的炎症性肉芽肿 5例 )作为对照。结果 :皮肤活检经Ｓ-1 0 0免疫过氧化物酶染色后观察到 4种神经受累形态 ,即神经浸润、断裂、缺如和形态完整。ＴＴ染色后及显示断裂的神经 (1 0 0 % )。而ＢＴ染色后显示神经浸润(7 2 % )断裂 (64 2 % )和神经缺如 (2 8 6% ) ,未见完整的神经。而 1 5例对照…     

聚维酮碘治疗四例麻风患者小腿、骶部及足底溃疡护理体会

麻风(leprosy)是一种由麻风分枝杆菌(Mycobacterium leprae)感染易感个体后主要侵犯皮肤和外周神经,晚期可致残的慢性传染病[1]。麻风溃疡是因麻风杆菌侵犯周围神经组织,导致血液供应循环障碍,局部神经性营养不良,造成感觉或运动障碍,在外界压力等因素作用下而造成的神经营养性溃疡。也可由麻风皮肤损害破溃引起,一般好发于足底、足跟、四肢关节,溃疡呈穿凿状,基底暗红,肉芽陈旧,表面有腐败坏死组织,常伴有周围浅神经粗大、皮肤干燥无汗、脱发、感觉功能障碍等,病程慢性,极难愈合,治疗困难,危害很大。轻者影响其日常生活,重者脱指(趾)、断肢、毁容残废、丧失劳动力,严重影响了麻风患者的康复[2]。给患者带来伤口疼痛、心理折磨、截肢、癌变甚至是死亡,对患者生活质量影响极其严重[3]。临床发现1%聚维酮碘抗菌洗液(东莞市中加消毒科技有限公司,粤卫消证字[2002]第0057号)配合10%聚维酮碘乳膏(厂家:广东科伦药业有限公司,批号:B18080502)用于麻风溃疡护理,取得较好疗效。现将护理体会汇报如下。     

麻风病

20 0 32 52 4　麻风 FD MDT的远期疗效观察 /李孟培 (云南永平县卫防站 )∥中国皮肤性病学杂志 .-2 0 0 3,17( 3) .- 181～ 182对采用 W HO 推荐的固定疗程联合化疗方案( FD M DT )治愈的 85例麻风病人 ,每年 1次连续观察 10年 ,总结其远期疗效。结果 :愈后稳定 81例 ,复发 4例 ( 4.71% ) ;畸残基本稳定 ,发生麻风反应 3例 ;细菌除复发者外全部阴转 ;色素沉着斑1年内消退 ;发生抑郁症 1例。提示 FDMDT的远期疗效确切、可靠。表 2参 5　 (刘彤 )2 0 0 32 52 5　 6 57例多菌型麻风改良 MDT复治后 17年监测 /景志春 (上海市皮肤性病医…     

陕西省70例新发麻风患者畸残情况分析

目的：分析陕西省2012-2017年新发麻风患者畸残情况。方法：采集中国麻风防治管理信息系统（LEPMIS）中陕西省新发患者数据，运用WPS office 2007软件建立数据库进行分析。结果：陕西省70例新发麻风患者1级畸残占42.86%、2级畸残占40.00%；周围神经累计损害351条，其中胫神经损害26.00%、尺神经损害25.00%、腓总神经损害19.00%、正中神经损害12.00%、耳大神经损害12.00%、面神经损害4.00%、桡神经损害2.00%、三叉神经损害0.00%；累及手足眼的2级畸残分别有17处、13处、11处。结论：麻风病所致周围神经损害严重的依次是胫神经、尺神经、腓总神经。     

The INFIR Cohort Study: assessment of sensory and motor neuropathy in leprosy at baseline

AIM: To compare different method(s) to detect peripheral neuropathy in leprosy and to study the validity of the monofilament test (MF) and the voluntary muscle test (VMT) as standard tests of nerve function. DESIGN: A multi-centre cohort study of 303 multibacillary (MB) leprosy patients. METHODS: Newly registered MB patients requiring a full course of MDT were recruited in two leprosy outpatient clinics in North India. Controls were people without leprosy or neurological conditions, attending the dermatological outpatient departments of the same clinics. Nerve function was evaluated electrophysiologically using standard parameters for sensory and motor nerve conduction (NC) testing, warm and cold detection thresholds (W/CDT), vibration perception thresholds, dynamometry, MF and VMT. The latter two defined the outcomes of sensory and motor impairment. RESULTS: 115 patients had nerve damage or a reaction of recent onset at diagnosis. Sensory and motor amplitudes and WDTs were the most frequently abnormal. Among the nerves tested, the sural and posterior tibial were the most frequently impaired. In the ulnar nerve, sensory latencies were abnormal in 25% of subjects; amplitudes in 40%. Ulnar above-elbow motor conduction velocities were abnormal in 39% and amplitudes 32%. WDTs were much more frequently affected than CDTs in all nerves tested. The thresholds of all test parameters differed significantly between controls and patients, while only some differed between patients with and without reaction. Good concordance was observed between MF results and sensory latencies and velocities (direct concordance 80% for the ulnar). However, a proportion of nerves with abnormal MF results tested normal on one or more of the other tests or vice versa. Concordance between VMT and motor conduction velocities was good for the ulnar nerve, but for the median and peroneal nerves, the proportion impaired by VMT out of those with abnormal motor conduction was very low. CONCLUSIONS: Concordance between monofilaments and other sensory function test results was good, supporting the validity of the monofilaments as standard screening test of sensory function. Concordance between VMT results and motor nerve conduction was good for the ulnar nerve, but very few median and peroneal nerves with abnormal conduction had an abnormal VMT. A more sensitive manual motor test may be needed for these nerves. Of the nerve assessment tests conducted, NC amplitudes and warm sensation were the most frequently affected. Therefore, nerve conduction studies and WDT measurements appear to be most promising tests for early detection of leprous neuropathy. The pattern of concordance between tactile and thermal sensory impairment failed to support the hypothesis that small fibre neuropathy always precedes large fibre damage. Warm sensation was more frequently affected than cold sensation. This could indicate that unmyelinated C fibres are more frequently affected than small myelinated Asigma fibres.     

Nerve function impairment in leprosy: design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage Study).

The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study designed to investigate epidemiological, diagnostic, therapeutic and operational aspects of acute nerve function impairment in leprosy. The study is based at a single centre in Bangladesh, in an area with a high prevalence of leprosy. The centre, Danish Bangladesh Leprosy Mission, has a well-established vertical leprosy control programme. In this paper, the study design and methodology are described, together with definitions of nerve function impairment (NFI) used in this and subsequent papers. The study recruited 2664 new leprosy cases in a 12-month period. The male:female ratio is 1.25:1, and 17.61% of the cohort are under 15 years of age. In all, 83.33% of the cohort are paucibacillary (PB), and 16.67% multibacillary (MB). However, the MB rate amongst males is 19.72%, and amongst females is 12.85%, despite an equal period of delay to diagnosis. 55% of patients presented for treatment within 12 months of developing symptoms 6.12% of the total number of cases were smear positive, and 36.71% of the MB cases were smear positive. 9.61% of the total number of cases were graded as having World Health Organisation (WHO) disability grade 1, and 5.97% had grade 2. Amongst MB cases, 27.48% had WHO grade 1 disability present, and 18.24% had grade 2 present, compared with 6.04% and 3.51%, respectively, amongst PB cases. A total of 11.90% of the cohort had sensory NFI of any kind, and 7.39% had motor NFI. Ninety patients presented with NFI needing treatment (3.38%), and of these, 61 (67.78%) had silent NFI. MB patients had a prevalence of reaction/NFI needing treatment nearly 7 times higher than PB cases (15.32% amongst MB; 2.30% amongst PB), and males nearly double that of females (5.67% amongst males, 2.96% amongst females). The most commonly affected nerve by function impairment was the posterior tibial (sensory) with 6.46% of nerves affected (9.38% of patients), followed by the ulnar nerve with 3.23% of nerves impaired (5.56% of patients). Future research and publications, building on this foundation, will focus on the following areas: the incidence of NFI and reactive events, the risk factors for developing NFI, and the response to treatment of patients developing acute NFI.     

The prognostic importance of detecting mild sensory impairment in leprosy: a randomized controlled trial (TRIPOD 2)

This study was designed to investigate whether leprosy patients diagnosed with mild sensory impairment have a better prognosis when treated with steroids than similarly impaired patients treated with placebo. A multi-centre, randomized, double-blind, placebo-controlled trial was conducted in Nepal and Bangladesh. Patients were eligible if they had a confirmed leprosy diagnosis, were between 15 and 50 years old, had mild sensory impairment of the ulnar or posterior tibial nerve of less than 6 months duration and did not require steroids for other reasons. 'Mild impairment' was defined as 'impaired on the Semmes-Weinstein monofilament test, but testing normal on the ballpen sensory test'. Subjects were randomized to either prednisolone treatment starting at 40 mg per day, tapering over 4 months, or placebo. Nerve function was monitored monthly. Any patient who deteriorated was taken out of the trial and was put on full-dose steroid treatment. Outcome assessment was done at 4, 6, 9 and 12 months from the start of the treatment. Outcome measures were the proportion of patients needing full-dose prednisolone and the Semmes-Weinstein sum scores. Each patient contributed only one nerve to the analysis. Seventy-five patients had nerves eligible for analysis, of whom 41 (55%) and 34 (45%) were allocated to the prednisolone and placebo arms, respectively. At 4 months, three patients in the prednisolone arm (7%) and six in the placebo arm (18%) had an outcome event requiring full dose steroids. At 12 months, these proportions had almost reversed, 11 (27%) and 6 (18%) in the treatment and placebo arms, respectively. In the latter group, 75% had recovered spontaneously after 12 months. Prednisolone treatment of sensory impairment of the ulnar and posterior tibial nerves detectable with the monofilament test, but not with the ballpen test, did not improve the long-term outcome in terms of recovery of touch sensibility, not did it reduce the risk of leprosy reactions or nerve function impairment beyond the initial 4-month treatment phase. Two unexpected main findings were the strong tendency of mild sensory impairment to recover spontaneously and the fact that patients with mild sensory impairment without any other signs or symptoms of reaction or nerve function impairment are relatively rare.     

S-100 as a useful auxiliary diagnostic aid in tuberculoid leprosy

BACKGROUND: The diagnosis of tuberculoid leprosy is often difficult on hematoxylin and eosin (H&E) due to the absence of demonstrable nerve destruction. This study evaluates the utility of S-100 staining in identifying nerve fragmentation and differentiation of tuberculoid leprosy from other cutaneous granulomatous diseases. METHODS: Fifty cases of leprosy including 38 borderline tuberculoid (BT), two tuberculoid (TT), and 10 indeterminate leprosy (IL) were studied. Eleven controls of non-lepromatous cutaneous granulomatous lesions were included. S-100 was used for identifying the following dermal nerve patterns: infiltrated (A), fragmented (B), absent (C), and intact (D) nerves. RESULTS: On H&E, only 18/38 (47.4%) BT cases and 1/2 (50%) TT cases revealed neural inflammation. On S-100 staining of BT cases, 28/38 (73.7%) showed pattern B followed by patterns C and A in 8/38 (21.1%) and 2/38 (5.3%) cases, respectively. Both the TT cases showed pattern B. Only intact nerves (D) were seen in all the control cases. S-100 identified nerve damage in 4/10 (40%) IL cases. The patterns A, B, and C had sensitivity, specificity, and positive and negative predictive values of 100% in diagnosing tuberculoid (BT + TT) leprosy. CONCLUSIONS: S-100 is superior to H&E in identifying nerve fragmentation (p < 0.01). It also aids the differential diagnosis of tuberculoid leprosy.     

The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India

The aim of this study was to find predictors of neuropathy and reactions, determine the most sensitive methods for detecting peripheral neuropathy, study the pathogenesis of neuropathy and reactions and create a bank of specimen, backed up by detailed clinical documentation. A multi-centre cohort study of 303 multibacillary leprosy patients in Northern India was followed for 2 years. All newly registered MB patients requiring a full course of MDT, who were smear positive and/or had six or more skin lesions and/or had two or more nerve trunks involved, were eligible. A detailed history was taken and physical and neurological examinations were performed. Nerve function was assessed at each visit with nerve conduction testing, warm and cold detection thresholds, vibrometry, dynamometry, monofilaments and voluntary muscle testing. Because the latter two are widely used in leprosy clinics, they were used as 'gold standard' for sensory and motor impairment. Other outcome events were type 1 and 2 reactions and neuritis. All subjects had a skin biopsy at registration, repeated at the time of an outcome event, along with a nerve biopsy. These were examined using a variety of immunohistological techniques. Blood sampling for serological testing was done at every 4-weekly clinic visit. At diagnosis, 115 patients had an outcome event of recent onset. Many people had skin lesions overlying a major nerve trunk, which were shown to be significantly associated with an increased of sensory or motor impairment. The most important adjusted odds ratios for motor impairment were, facial 4.5 (1.3-16) and ulnar 3.5 (1.0-8.5); for sensory impairment they were, ulnar 2.9 (1.3-6.5), median 3.6 (1.1-12) and posterior tibial 4.0 (1.8-8.7). Nerve enlargement was found in 94% of patients, while only 24% and 3% had paraesthesia and nerve tenderness on palpation, respectively. These increased the risk of reactions only marginally. Seven subjects had abnormal tendon reflexes and seven abnormal joint position sense. In all but one case, these impairments were accompanied by abnormalities in two or more other nerve function tests and thus seemed to indicate more severe neuropathy. At diagnosis, 38% of a cohort of newly diagnosed MB leprosy patients had recent or new reactions or nerve damage at the time of intake into the study. The main risk factor for neuropathy found in this baseline analysis was the presence of skin lesions overlying nerve trunks. They increased the risk of sensory or motor impairment in the concerned nerve by 3-4 times. For some nerves, reactional signs in the lesions further increased this risk to 6-8 times the risk of those without such lesions. Patients with skin lesions overlying peripheral nerve trunks should be carefully monitored for development of sensory or motor impairment.     

Nerve thickening in leprosy patients and risk of paralytic deformities: a field based study in Agra, India

This paper examines the extent of nerve thickening among leprosy patients detected in the field in Agra district. All the clinically diagnosed leprosy patients were examined in detailed for thickening of local cutaneous nerves and peripheral nerve trunks. In each case all the major nerve trunks in both upper and lower extremities, forehead and neck were examined for thickening. Nerve thickening was found in 94% of multibacillary (MB) patients and among 52% paucibacillary (PB) patients. Nerve thickening was found to be more in males, in prevalent cases than in new (untreated) cases and increased significantly with age and delay in diagnosis (P<0.001). Visible deformities of grade > or =2 were found in 10% (58/573) of the leprosy patients; paralytic deformity accounted for 78% (45/58). Claw hand alone or in combination was seen in 82% (37/45) of patients with paralytic deformities. Risk (odd ratio) for deformities was observed to be high (15-18 times) with increasing number of nerves among patients with neuritic leprosy but correlated with delay in diagnosis of over 5 years. Likewise, deformities were more often seen in those with skin lesions, provided they had > or =3 thickened nerves. Findings suggest that early detection and treatment is useful in preventing deformities.