多菌型麻风患者联合化疗6个月后停药随访7年结果分析

目的:分析多菌型麻风患者经过6个月联合化疗后停药,随访7年的结果。方法:对新发或复发未经治疗的多菌型麻风患者给予WHO联合化疗多菌型方案治疗6个月,停药后观察7年,评价临床和细菌学疗效。结果:共收录多菌型麻风患者114例,中途退出43例,71例纳入分析。疗前患者平均细菌指数为2.93±1.39,停药满7年时所有患者细菌指数阴转,平均年下降0.42。7年中共观察到麻风反应38人次,反应频率为53.5%。有1例在停药13个月时复发,复发率为0.05/100人年。结论:多菌型麻风患者6个月联合化疗有效。联合化疗6个月患者的细菌指数变化和麻风反应与报告的经1年或2年联合化疗的多菌型患者情况相似。     

统一联合化疗和常规联合化疗后多菌型麻风患者的细菌指数变化和麻风反应率比较

目的 评价统一联合化疗（UMDT）后多菌型麻风患者的细菌指数变化和麻风反应频率,并与常规联合化疗（RMDT）后多菌型患者的结果比较。方法 2003-2005年在贵州3个地区和云南1个地区收集新麻风患者,给予6个月WHO多菌型联合化疗方案。对照组为同一地区接受2年RMDT的多菌型麻风患者,所有患者接受每年1次临床随访和细菌检查。对两组患者的细菌学数据和临床麻风反应频率进行比较。结果 共166例各种类型麻风患者接受UMDT,其中114例为疗前细菌检查阳性的多菌型患者,有83例已经随访42个月。同一地区新登记疗前查菌阳性并接受RMDT的多菌型麻风患者170例,其中149例具有48个月完整细菌资料。接受UMDT的83例患者从治疗后到42个月,平均细菌指数从疗前2.84下降到0.33,同时61例患者（73.55%）细菌指数阴转。接受RMDT的149例多菌型患者,在开始治疗后到48个月,平均细菌指数从疗前的2.55下降到0.26,其中有115例患者（77.2%）细菌指数阴转,两组平均细菌指数变化之间差异无统计学意义（t = 0.77,P > 0.05）,细菌指数阴转率差异无统计学意义 （?字2 = 0.40,P > 0.05）。UMDT组有13例患者（14.6%）在观察期发生麻风Ⅰ型反应,而RMDT组只有5例 （3.4%）在观察期发生麻风Ⅰ型反应,两组间差异有统计学意义（?字2 = 10.08,P < 0.01）。结论 在观察期末,UMDT组和RMDT组在细菌指数变化和阴转率上差异无统计学意义。UMDT组Ⅰ型反应发生率高于RMDT组,其原因值得进一步研究。     

27例多菌型麻风联合化疗三年细菌指数变化

绵阳市中区 1988～ 1990年开展了麻风病的联合化疗 (ＭＤＴ)其中多菌型 (ＭＢ)病人2 7例 ,采用ＭＤＴ中的ＭＢ方案治疗 ,疗期 2年 ,均已进入监测期 ,我们对其进行了 3年的细菌指数 (ＢＩ)变化观察 ,结果如下。一般情况　 2 7例患者中 ,男 2 5例 ,女2例 ,年龄 13～ 6 1岁。病期 2～ 2 8年 ,平均病期 9.5年 ,院内病人 10例 ,院外病人 17例。按 5级分类法 :ＬＬ 2 5例 ,ＢＬ 1例 ,ＢＢ 1例 ,均为经治病例。ＭＤＴ前曾接受过其它抗麻风治疗 ,疗期为 1～ 2 6年 ,部分病例还短期服用过利福平。方法　 2 7例患者按ＷＨＯ(世界卫生组织 )推荐的ＭＤ…     

157例MB麻风MDT后的细菌变化及复发

为评价用ＭＤＴ后ＭＢ麻风的远期复发率，对江苏扬州地区和东台市１９８３￣１９９３年登记的７１１例ＭＢ麻风连续用ＭＤＴ至皮肤查菌阴性，从中选择疗前ＢＩ≥２．６和１９９０年１２月以前停药者进行随访，共１５７例，其中６５例（４１．４％）已停药随访７年以上；达到皮肤查菌阴性者，用ＭＤＴ时间最短者为２年，最长者为６年（平均为４７．７月）；治疗４年时的阴转率为７５．１６％，５年为９７．４５％，５年内ＢＩ年均下降     

157例 MB 麻风 MDT 后的细菌变化及复发

为评价用 MDT 后 MB 麻风的远期复发率,对江苏扬州地区和东台市1983～1993年登记的711例 MB 麻风连续用 MDT 至皮肤查菌阴性,从中选择疗前 BI≥2.6和1990年12月以前停药者进行随访,共157例,其中65例(41.40%)已停药随访7年以上;达到皮肤查菌阴性者,用 MDT 时间最短者为2年,最长者为6年(平均为47.7月);治疗4年时的阴转率为75.16%,5年为97.45%,5年内 BI 年均下降0.69;共随访946人年,平均每例随访6.02年,有2例分别在停药3年和4.5年时复发(1.3%或2.1/1000人年)。本组资料表明,高菌量的 MB,用 MDT 后的复发率并不更高。应该加强监测,进一步积累复发资料来评价 MDT 的远期疗效。     

多菌型麻风患者统一联合化疗后5年疗效评价

@@@@目的：评价多菌型麻风患者统一联合化疗后停药5年的疗效。方法：对新发或复发未经治疗的多菌型麻风患者给予WHO联合化疗多菌型方案治疗6个月,然后停药观察5年,评价临床和细菌学疗效。结果：共收录多菌型麻风患者114例,中途退出35例,79例纳入分析。疗前患者平均细菌指数为2．88±1．38,停药满5年时的平均细菌指数为0．05,平均年下降0．56。停药5年时患者细菌阴转率为89．9％。5年研究中共观察到麻风反应38人次,反应率为48．1％。仅1例在停药13个月时复发。结论：多菌型麻风患者6个月联合化疗有效。患者的细菌指数变化和麻风反应与报告的多菌型患者经1年或2年联合化疗后大体一致。     

统一联合化疗和常规联合化疗后多菌型麻风患者的细菌指数变化和麻风反应率比较北大核心CSCD

目的评价统一联合化疗（UMDT）后多菌型麻风患者的细菌指数变化和麻风反应频率,并与常规联合化疗（RMDT）后多菌型患者的结果比较。方法2003-2005年在贵州3个地区和云南1个地区收集新麻风患者,给予6个月WHO多菌型联合化疗方案。对照组：为同一地区接受2年RMDT的多菌型麻风患者,所有患者接受每年1次临床随访和细菌检查。对两组患者的细菌学数据和临床麻风反应频率进行比较。结果共166例各种类型麻风患者接受UMDT,其中114例为疗前细菌检查阳性的多菌型患者,有83例已经随访42个月。同一地区新登记疗前查菌阳性并接受RMDT的多菌型麻风患者170例,其中149例具有48个月完整细菌资料。接受UMDT的83例患者从治疗后到42个月,平均细菌指数从疗前2．84下降到0．33,同时61例患者（73．55％）细菌指数阴转。接受RMDT的149例多菌型患者,在开始治疗后到48个月,平均细菌指数从疗前的2．55下降到0．26,其中有115例患者（77．2％）细菌指数阴转,两组平均细菌指数变化之间差异无统计学意义（t=0．77,P〉0．05）,细菌指数阴转率差异无统计学意义（r=0．40,P〉0．05）。UMDT组有13例患者（14．6％）在观察期发生麻风I型反应,而RMDT组只有5例（3．4％）在观察期发生麻风I型反应,两组间差异有统计学意义（r=10．08,P〈0．01）。结论在观察期末,UMDT组和RMDT组在细菌指数变化和阴转率上差异无统计学意义。UMDT组I型反应发生率高于RMDT组,其原因值得进一步研究。     

656例MB麻风短程MDT后的监测

６５６例ＭＢ型麻风用ＷＨＯ－ＭＤＴ２４个月，停药后监测１－８年，临床显著进步６２９例，进步２３例，有效率为９９．３９％。监测５年累计细菌阴转５３５例，在初治者４０２例中为９９．４６％，经治者２５４例中为９９．１８％；治疗前ＢＩ〈３．０的２９９例中监测５年累计阴转率为１００＾，ＢＩ≥３．０的３５７例中为９９．４％。     

Three years assessment of multidrug therapy in multibacillary leprosy cases

Analysis of Bacteriological Index (BI) of 584 multibacillary leprosy patients who had completed multidrug therapy (MDT) as per the recommendations of World Health Organization (WHO) and Indian Association of Leprologists (IAL) showed smear conversion rates of 56% at 24 doses and 66% at 36 doses. Taking BI as a parameter of judgement, the results indicate distinct improvement over the performance achieved through dapsone monotherapy during earlier period. IAL regimen consisting of daily initial administration of rifampicin for 21 days did not show any distinct advantage over WHO regimen. Bacteriological decline was uniformally noticeable in all patients though in cases with high initial BI, smear conversion rate was much less. All the six patients with BI more than 5, and 59 patients (70%) with BI 1 to 4.9 and 87 patients (64%) with BI 3 to 3.9 have not been rendered negative even after three years of treatment. On the contrary seventeen patients whose skin smears were still positive after receiving 24 supervised doses became bacteriologically negative subsequently, and remained so though chemotherapy was stopped. Such studies on large number of patients for a longer period is essential to establish whether chemotherapy should necessarily be continued up to the point of negativity.     

Relapse rate in paucibacillary leprosy patients after multidrug therapy in North Arcot District

Surveillance data from 14,227 paucibacillary (PB) patients who had been released from treatment one year earlier, after completing multidrug therapy (PB regimen) for 6 to 12 months, were analysed to assess relapse rates and the influence of three variables, viz., number of lesions, nerve involvement and duration of treatment. The overall relapse rate at one year of surveillance was acceptably low at 0.34%. Relapse rates were about four times higher when there were many (4-9) lesions, or, when nerve was involved (0.80% cf 0.20%). Extending the duration of treatment beyond 6 months did not reduce the relapse rates significantly in the high risk groups. Detection of PB cases early, before these risk factors become operative, and treating them with MDT would appear to be the best strategy to minimize relapse rates.     

Relapse of paucibacillary leprosy after short course multidrug therapy

Among 25 patients who had short-course multidrug therapy as recommended by the WHO for paucibacillary leprosy, 3 were observed to develop relapse of their disease 8 to 12 months after completion of treatment. These three cases of relapse are reported in detail. The duration of chemotherapy recommended by the WHO in paucibacillary cases appears to be too short.     

A bacteriological assessment of multibacillary cases in leprosy colonies after 4 1/2 years of multidrug therapy

In this presentation we have devised a novel way of calculating the total bacterial quantum in 100 (78 LL and 22 BL) multibacillary leprosy patients living in leprosy colonies. The calculation is based on Ridley's logarithmic scale. We have also attempted to assess the reduction in the bacterial quantum as a result of intervention through multidrug therapy (MDT). 53% of the patients rendered bacteriologically negative within two years of treatment of MDT and 94% at 54th pulse dose i.e. at 54th month. The bacterial quantum in human source as leprosy patients was calculated thus--Average BI of the group X Number of patients in each group X Multiplication factor devised as per Ridley's Bacterial Index (BI). By applying this purely arithmetic formula, it was found that 99.8% of the bacterial load is harboured in leprosy patients having BI more than 3. The introduction of MDT initiated the reduction in total bacterial quantum "based on above arithmetic scale" was achieved very fast i.e., from 100% to 5% at 12 months and to 0.4% at 24 months. We believe that if one wants to achieve leprosy control through a reduction in total bacterial quantum within a specific period, leprosy cases with BI more than 3 should be treated on priority basis.     

Paucibacillary multidrug therapy in leprosy. 7 1/2 years experience.

Three hundred and twenty-three paucibacillary (PB) leprosy patients were treated with WHO-recommended multidrug therapy (MDT) and followed up for over 7 1/2 years. The paucibacillary MDT regimen (PBR) was well accepted and tolerated. Complete clinical regression was attained in 61.2% patients after 6 doses of PBR. Persistence of clinical activity after 6 months of therapy was associated with occurrence of type I upgrading reaction, presence of six or more patches and more than two thickened major nerve trunks. Reversal reactions were encountered in 15.9% patients, one third of which were accompanied by severe neuritis. Delayed upgrading reaction occurred in six patients, two patients had relapse one and two years after stopping of PBR. The WHO recommended MDT regimen for paucibacillary cases needs careful evaluation and it may be necessary to extend the treatment beyond six months in certain situations.     

Clinico-histopathological study of multidrug therapy in indeterminate leprosy

A study was undertaken in 42 patients with indeterminate leprosy to evaluate the efficacy of multidrug therapy (MDT) in Indeterminate leprosy for 12 months. The main clinical finding was a single hypopigmented macule in 31 (73.8%) of the 42 cases. Histopathologically all cases showed lymphohistiocytic infiltration around skin appendages and dermal nerves. At the end of six months of MDT all the cases were evaluated clinically and 33 (85.5%) showed marked improvement or total inactivation while the lesions were still active clinically in 21.4% cases. Histopathological examination of lesions in 30 patients showed complete histological resolution in 9 cases only. At the end of one year of treatment it was found that 28 cases (66.3%) had become inactive and only 2 (4.7%) were found to be still active.     

Bacillaemia in leprosy and effect of multidrug therapy

Twenty-five patients of bacilliferous leprosy (17 LL, 8 BL) were studied by the modified haemolysis method for occurrence of bacillaemia and its clearance after two multidrug therapy regimens. Acid-fast bacilli were found in 76% of all patients and in 88.2% LL and 50% BL patients. Bacillaemia occurred with significantly reduced frequency in patients with type II reaction. Acid-fast bacilli were demonstrable in peripheral blood after 1 month in one patient on MDT of an Indian Working Group and 3 lepromatous patients on WHO multidrug therapy. However, bacillaemia could not be demonstrated in any patients after 2 and 3 months of treatment with both regimens.