280例联合化疗病人麻风反应危险因素分析

目的:确定联合化疗(MDT)病人麻风反应相关危险因素.方法:对280例登记MDT麻风病人的临床资料进行回顾性分析.结果:280例麻风病人中I型和II型麻风反应的发生率分别为11.4%和19.3%.51.6%的麻风反应发生在MDT前,37.5%的I型麻风反应发生在MDT开始后的1年内,45.4%的II型麻风反应分别发生在MDT开始后的2年内.疗前细菌指数>4.0是II型麻风反应的危险因素.结论:MDT治疗的2年内是麻风反应监测的重点.     

麻风治愈留院者抑郁及其影响因素研究

使用抑郁自评量表测定我所120例麻风治愈留院者的抑郁情况,同时对与抑郁可能相关的性别,年龄,文化,健康状况,经济状况,人际关系等12个因素进行调查。结果:麻风治愈留院者中存在抑郁,占25%(30/120),以轻度抑郁居多(73.33%),其抑郁总粗分较常模无显著性差异。影响麻风治愈留院者抑郁的因素主要为年龄,健康状况,人际关系。对其躯体健康状况及社区环境等进行干预可以改善其心理健康水平。     

麻风治愈留院者述情障碍及其相关因素研究

为研究麻风治愈留院者的述情障碍及其影响因素，使用多伦多述情障碍量表（TAS-26）对我所120例麻风治愈留院者进行调查，并使用SPSS12．0软件进行统计学处理。结果：麻风治愈留院者的述情障碍总分及因子1，2，4的分明显高于常模，因子3的分低于常模。述情障碍的影响因素主要为一般健康状况，生活满意度，人际关系。麻风治愈留院者的述情障碍很可能是机体对麻风及其相关的心理社会因素的一种状态性反应，要重视麻风患者述情障碍问题，消除其可能的影响因素，并进行针对性心理干预，以提高患者健康水平。     

麻风患者复杂性足底溃疡及其影响因素

为进一步探讨麻风患者复杂性足底溃疡的影响因素,作者对180例治愈留院者进行了专项调查,现将结果报道如下。1研究对象与方法1.1研究对象我院及来自我省其它市(县)部分治愈留院的麻风患者共计180例(男156例,女24例);复杂性足底溃疡68例,非复杂性足底溃疡112例;型别:MB143例,PB37例;溃疡病程为3个月~56年,其中10年以上者有62例;患者年龄40~85岁,平均(67.36±9.48)岁。1.2研究方法对被调查的麻风治愈留院者按照统一制作的调查表,由我院医生逐一进行调查、填表。调查项目包括:年龄、型别、文化程度、营养状况、经济状况、健康状况、胫神经损害…     

泼尼松联合沙利度胺治疗重度II型麻风反应患者的疗效评价

目的：评价泼尼松联合沙利度胺治疗重度II型麻风反应患者的疗效。方法：重度II型麻风反应患者38例给予泼尼松30mg/d早晨顿服同时给予沙利度胺100mg/次,每日 3次,待症状控制后逐渐减量至停药,总疗程 4个月。结果：重度II型麻风反应患者痊愈率86.84％、显效率94.73％。结论：泼尼松联合沙利度胺治疗重度II型麻风反应患者疗效显著     

联合化疗中麻风反应的临床特征及糖皮质激素治疗的效果分析

目的了解麻风联合化疗时麻风反应的发生情况,评价糖皮质激素对麻风反应的治疗效果。方法对本市1986-2005年采用联合化疗方案治疗后达到临床治愈的新发及复发麻风病人的临床资料进行回顾性分析。结果 63例进行联合化疗的麻风患者,有37例曾经发生72例次麻风反应,23例发生Ⅰ型麻风反应34例次,15例发生Ⅱ型麻风反应31例次,7例发生混合型麻风反应7例次;且73.53%麻风反应发生在联合化疗1年内,Ⅱ型麻风反应均出现在联合化疗1年后,但是混合型麻风反应出现时间不一。麻风反应以皮肤和周围神经症状为主要表现,其中Ⅰ型、Ⅱ型和混合型麻风反应发生时有皮肤症状者分别占64.71%,100%和100%,有神经受累者分别占100%,61.29%和42.86%。治愈24例次,显效19例次,好转21例次,无效0例次,恶化8例次,有效率为59.72%。糖皮质激素治疗后25例次(34.72%)出现胃部不适,16例次出现满月脸多血质,7例次出现骨质疏松症样疼痛,但是均未影响治疗。结论麻风联合化疗患者麻风反应高发,神经受累相对较多,激素治疗麻风反应有一定的效果,但治疗方案仍有改进的空间。     

麻风眼病及其相关因素的调查

对四川凉山州和攀枝花市现存的现症麻风患者和治愈者随机抽样调查,在2145人中发现1570人患有各种眼病(73.19％),其中麻风性眼病465人(21.68％);最常见的是角膜感觉障碍和兔眼,与患者的年龄及文化程度及诊断时的年龄和麻风病期、型别、细菌指数与麻风反应等密切相关。对白内障的分析证明,本组患者的白内障与麻风无明显关系。     

麻风病

使用综合方法治疗麻风足底溃疡的效果观察；结核样型麻风1例；PB型麻风复发转型2例；麻风治愈留院者心电图分析；健康教育与健康促进在麻风畸残康复中的效果观察；对“盐城市1996-2005年麻风防治情况分析”一文的商榷。     

麻风眼病人及其相关因素的调查

对四川凉山州和攀枝花市现在的现症麻风患者和治愈者随机抽样调查，在２１４５人中发现１５７０人患有各种眼病（７３．１９％），其中麻风性眼病４６５人（２１．６８％）；最常见的是角膜感觉障碍和兔眼，与患者的年龄及文化程度及诊断时的年龄和麻风病期、型别、细菌指数与麻风反应等密切相关。对白内障的分析证明，本组患者的白内障与麻风无明显关系。     

麻风治愈留院者心电图分析

近年来心血管疾病的发生率和死亡率明显增高,其诊断仪器也日新月异,但心电图仍是最为经济、简便和实用且不可缺少的检查方法。有关老年人心电图已有大量报道[1],也有对福利院老年人的心电图调查[2],但未见对麻风患者心电图的探讨。为了了解我院麻风留院者心电图情况,我们于2004年6~7月间对我院127例中老年麻风治愈留院者进行了心电图检查,为麻风患者老年性疾病的预防和临床诊治提供依据,现将结果报道如下:1资料与方法1.1对象对我院127例留院患者进行心电图检查分析,其中男109例,女18例,年龄41~85岁,平均69.6±10.1岁,41~60岁27人,占21.3%,男…     

云南勐腊县391例麻风新发病人畸残影响因素分析

目的：分析勐腊县近70年麻风新发患者畸残情况及影响因素。方法：收集勐腊县历年麻风患者资料,采用二元logistic回归分析方法分析麻风畸残的影响因素。结果：共分析勐腊县麻风患者391例,麻风新发病例畸残率46.04%（180/391）,其中2 级畸残率44.50%（174/391）。延迟期2～5年、5～10年、≥10年的麻风患者发生畸残风险分别是延迟期＜2年的2.49倍（P=0.018）、4.8倍（P＜0.001）和14.56倍（P＜0.001）;家外传染的麻风畸残风险是家内传染的1.93倍（P=0.030）;有麻风反应的麻风畸残风险是没有反应的2.36倍（P=0.010）;神经损害数2～4条和＞4条的麻风畸残风险分别是神经损害1条的3.37倍（P=0.029）和5.09倍（P=0.009）。结论：勐腊县麻风畸残的危险因素主要有延迟期、家外传染、麻风反应、神经损害数。     

128例麻风患者眼病与视力调查分析

目的：了解当前麻风患者的眼病患病情况及其视力下降原因。方法：检查128例住院麻风病人眼病及其视力。结果：100例患者（78．13％），189只眼（73．83％）有眼病，主要眼病为兔眼（45．70％），角膜病变（34．77％），角膜感觉障碍（32．42％），陈旧性虹睫炎（26．56％），白内障（23．44％），下睑外翻（17．19％）等，8l例患者（63．28％），144只眼（56．25％）有视力下降，引起视力下降的主要原因依次为白内障（38．19％），角膜病变（25．69％），虹睫炎（19．44％）。结论：随着麻风病人年龄增长，白内障在其视力下降中作用突出，要加强防治，对其他眼疾，也要训练病人进行自我护理，防止眼病加重及视力下降。     

Eye lesions in leprosy

Out of 742 out-patients screened for ocular disease, 177 (24%) had eye lesions due to leprosy. These were more in the lepromatous spectrum of the disease and showed increasing trend with age of patient and duration of the disease. Madarosis was the commonest lesion (76%). The serious and sight threatening lesions like lagophthalmos, corneal anaesthesia, corneal opacities and ulcers, iritis and complicated cataracts constituted 8.22% of the lesions. Blindness due to corneal opacity and complicated cataract developed in 6 patients, constituting 3.4% of eye lesions with a prevalence rate of 0.8% among all the leprosy patients. Although the blinding lesions occurred in a very small percentage of patients, most of these are preventable through early recognition and institution of appropriate treatment. The simple techniques of examination to detect potentially sight threatening lesions should be taught to all leprosy workers to prevent blindness among leprosy patients.     

Guillain-Barré syndrome-like presentation in borderline leprosy with type-2 reaction

A 46-year-old man with borderline lepromatous leprosy with type-2 reaction being treated with multi-bacilliary-multiple drug therapy and steroids presented with an acute onset of flaccid quadriparesis. A nerve conduction study and CSF analysis were similar to that seen in Guillain Barre syndrome. Muscle weakness improved considerably with an increased dose of corticosteroid; after 6 months the patient recovered completely.     

Does concomitant hiv infection has any epidemiological, clinical, immunopathological and therapeutic relevance in leprosy?

Co-infection with HIV-1 and M. Leprae is a rare event in endemic areas for leprosy and HIV, such as India. Neither an increased HIV prevalence among leprosy cases, nor any rapid progression to AIDS was observed among dual HIV-leprosy infections. The current situation concerning continued new leprosy case-detection and gradual increase in HIV infection in India and a few other developing countries, such as Brazil, emphasizes the importance of monitoring the occurrence of co-infections. There is so far no change in the clinical spectrum of leprosy, PB/MB ratio, leprosy reactions and neuritis among co-infected patients. All types of leprosy occur in HIV patients [except in one study (Borgdorff et al, 1993) where more MB leprosy cases with HIV infection were seen]. Histopathological observations reveal a normal spectrum of appearance in biopsies of leprosy lesions from co-infected patients suggesting that cell-mediated immune response to M leprae is preserved at the site of the disease, despite evidence that these responses are abrogated systemically. All dual infection cases respond to regular treatment, except in three studies which noted more relapses. Therefore, a longer duration of surveillance is advisable after fixed duration therapy, for the detection of early relapse. Type 2 reaction can be managed with a higher dose of clofazimine. Type 1 reaction when developed as such, or as IRIS, needs oral steroids in adequate doses, particularly when associated with neuritis and motor loss, since lower doses may not be able to reverse the motor loss even of early onset. However, higher doses of corticosteroid when given need to be monitored closely. The impact of immune restoration in co-infected patients receiving ART is commonly observed in cases with borderline leprosy.     

酚糖酯-免疫球蛋白M和鼻分泌物中麻风菌PCR检测在麻风流行病学中的应用

目的通过对流行乡村(同烘和南丘)麻风病患者、家内接触者及普通人群麻风菌感染的检测,评估实验流行病学对预测麻风病传播的意义。方法采用酚糖酯-酶联免疫吸附试验(PGL-ELISA)和检测鼻携带麻风菌的PCR方法,开展流行病学调查。结果(1)麻风病家内接触者的酚糖酯-免疫球蛋白M(PGL-IgM)阳性率和PCR检测的麻风菌鼻携带率分别为30.4%和23.1%;但PGL抗体阳性率在家内接触者和普通村民之间却无显著性差异。(2)两村普通村民的PGL-IgM阳性率,在统计学上无显著差异。然而,在<20岁的年龄组中,同烘村的PGL-IgM阳性率却显著高于南丘村。无论同烘或南丘村,PGL-IgM阳性率高峰均在<20岁的年龄组。随年龄的增加,阳性率逐渐下降。此外,女性的PGL-IgM阳性率高于男性。结论两村的新发现病人主要为年轻人,这与两村PGL-IgM阳性高峰位于<20岁年龄组相关。在<20岁的年龄组中,同烘村的PGL-IgM阳性率显著高于南丘村,除与同烘村患病率和发现率均高于南丘村相关,也与消除麻风病运动(LEC)后,同烘村仍有新病人出现有关。这一现象似乎支持麻风患病率与PGL-IgM阳性率相关。为评价麻风病的传播是否得到控制,以PGL的血清学仍是一种有用的方法。     

Risk factors for the development of clinical leprosy among contacts, and their relevance for targeted interventions

Existing knowledge on risk factors for the development of clinical leprosy among contacts of known leprosy patients is reviewed with the aim to identify factors associated with leprosy among contacts that have potential for developing effective targeted interventions in leprosy control. Different definitions of 'contact' have been used and most studies on this subject were among so-called household members. Yet several studies indicate that contacts found in other places than the household are also at risk of developing leprosy. The type of leprosy and the bacterial index are the main patient-related factors involved in transmission, but also contacts of PB patients have a higher risk of contracting leprosy as compared to the general population. The most important contact-related factors are the closeness and intensity of the contact and inherited susceptibility, while the role of age and sex of the contacts is not clear. The role of socio-economic factors is also vague. The significance of immunological and molecular markers in relation to risk of transmitting or developing leprosy is not yet fully understood, but there is an indication that contacts who are sero-positive for anti-PGL-I antibodies are at increased risk of developing clinical leprosy. The presence of a BCG scar is likely to be related to a lower risk. Analogies with tuberculosis suggest that the 'stone-in-the-pond' approach to control may be applicable to leprosy too. Sputum smear negative tuberculosis patients are known to spread the bacteria to others. This analogy strengthens the suggestion that the contacts of paucibacillary leprosy cases should also be included in contact tracing and examination. It is concluded that targeted interventions should be aimed at close contacts of both MB and PB patients inside and outside the household, particularly when genetically related.     

低流行状态下老年麻风患者的临床和流行病学特征研究

目的:了解陕西省老年麻风患者临床和流行病特征。方法:通过中国麻风管理信息系统(LEPMIS),对陕西省2004年1月至2022年1月收治的麻风患者进行回顾性描述性研究。结果:2004年1月至2022年1月期间,该地区共收治新发麻风病例323例,其中54例(16.7%)≥60岁,平均年龄为67.0岁,77.8%为男性;96.3%为低收入人群,57.4%文化程度低下(文盲或半文盲),79.6%有婚史,29.6%为家内传染。70.4%查菌结果为阳性,其中多菌型比例高达83.3%。虽然确诊时存在严重皮损(皮损>5块)的患者比例高达75.9%,存在严重神经损害(神经≥2条损害)的比例高达68.5%,二级畸残的比例高达53.7%,但83.3%的患者确诊时无明显的麻风反应。结论:本地区老年麻风患者伴随严重的皮肤、神经损害及畸残风险,提示在此人群中可能存在较长的诊断延迟期。     

Adverse events of standardized regimens of corticosteroids for prophylaxis and treatment of nerve function impairment in leprosy: results from the 'TRIPOD' trials

Reactions in leprosy causing nerve function impairment (NFI) are increasingly treated with standardized regimens of corticosteroids, often under field conditions. Safety concerns led to an assessment of adverse events of corticosteroids, based on data of three trials studying prevention of NFI (the TRIPOD study). A multicentre, randomized, double-blind placebo-controlled trial was conducted in leprosy control programmes in Nepal and Bangladesh. Treatment was with prednisolone according to fixed schedules for 16 weeks, starting in one trial with 20 mg/day (prophylactic regimen: total dosage 1.96 g) and in the other two trials with 40 mg/day (therapeutic regimen: total dosage 2.52 g). Minor adverse events were defined as moon face, fungal infections, acne, and gastric pain requiring antacid. Major adverse events were defined as psychosis, peptic ulcer, glaucoma, cataract, diabetes and hypertension. Also, the occurrence of infected plantar, palmar, and corneal ulceration was monitored, together with occurrence of TB. Considering all three trials together, minor adverse events were observed in 130/815 patients (16%). Of these, 51/414 (12%) were in the placebo group and 79/401 (20%) in the prednisolone group. The relative risk for minor adverse events in the prednisolone group was 1.6 (P = 0.004). Adverse events with a significantly increased risk were acne, fungal infections and gastric pain. Major adverse events were observed in 15/815 patients (2%); 7/414 (2%) in the placebo group and 8/401 (2%) in the prednisolone group. No major adverse events had a significantly increased risk in the prednisolone arm of the trials. No cases of TB were observed in 300 patients who could be followed-up for 24 months. Standardized regimens of corticosteroids for both prophylaxis and treatment of reactions and NFI in leprosy under field conditions in developing countries are safe when a standard pre-treatment examination is performed, treatment for minor conditions can be carried out by field staff, referral for specialized medical care is possible, and sufficient follow-up is done during and after treatment.