1260例多菌型麻风短程联合化疗后的监测

复发与控制复发是麻风防治工作的重要环节,是评价治疗方案的主要指标。造成麻风复发的主要原因:一是部分患者产生耐药菌;二是麻风持久菌的长期存在。1986年,我国开始在全国推行联合化疗(MDT)方案。贵州省黔西南州作为麻风高流行区于同年实施短程MDT治疗麻风,累计治疗1260例MB麻风病人,其中包括625例新发现病人和635例经过DDS(氨苯砜)或DDS+RFP(利福平)或DDS治愈复发的活动性病人,疗效评价按麻风防治手册标准,并对完成短程MDT疗程停药后的病人进行1～9年随访监测。现报道如下。     

联合化疗抗麻风复发监测

绍兴县是麻风高流行区,复发已成为阻碍本地区患病率下降的主要因素之一。因此,控制复发是麻风防治中的重要环节,采取何种方法控制或减少复发是一个需要研究的课题。我们对234例服氨苯砜(DDS)单疗程治愈者,使用联合化疗(MDT)复治6个月,连续监测9年,现报道如下。临床资料1．一般资料:1989年对DDS单疗程治愈者中抽取234名作为抗复发治疗的对象,其中瘤型(LL)144例,界线类偏瘤型(BL)16例,中间界线类(BB)20例,界线类偏结核样(BT)20例,结核样型(TT)34例。其中男186例,女48例。年龄最小30岁,最大70岁,平均51.5岁。将其余的1146例单疗程治愈者作为对照组。     

新发麻风病100例流行病学特征分析

目的分析100例新发麻风病例的流行病学特征。方法依据病历和报表中所载的病例发现相关的信息,对100例患者的发现方式、病程、患病类型、畸残情况进行分析。结果 100例病例中,家属体检发现23例,疫点普查发现5例,线索调查发现72例。病期:家属病例平均7个月,疫点病例平均9个月,线索病例平均23个月。患病类型:家属病例中,PB麻风病例20例占86.96%,MB麻风病例3例占13.04%;疫点病例中,PB麻风病例4例占80%,MB麻风病例1例占20%;线索病例中,PB麻风病例19例占26.39%,MB麻风病例53例占73.61%。畸残:家属病例无Ⅱ级畸残病例,疫点病例Ⅱ级畸残率20%,线索病例Ⅱ级畸残率34.72%。结论线索调查为发现病例的主要方式,家属检查为发现病例的重要方式。应当继续搞好线索调查工作,同时积极开展家属检查、疫点普查、疑似病例自报等主动发现病例工作,以能够早期发现病例缩短病期、减轻病情、减少畸残、降低危害。     

安徽省2000～2006年新发现麻风病人情况分析

目的分析2000-2006年安徽省麻风病流行状况和发展趋势,寻找麻风防治中存在的问题,确定今后工作重点,为进一步控制麻风提供决策依据。方法调查2000~2006年安徽省新发现麻风患者情况,采用EX-CEL2003对各流行病学指标进行统计分析。结果2000~2006年全省新发麻风患者189例,其中男130例,女59例,男女之比2.2∶1;多菌型(MB)133例,少菌型(PB)56例,MB与PB之比为2.4∶1。新发病人地域分布广泛,农民发病数最多,发病年龄为13~82岁,主要在麻防专业机构发现。189例新发患者中确诊时为Ⅱ级畸残者39例,患者确诊平均延迟期为39个月,新发现患者中有65例为家庭内感染。结论安徽省麻风病处于低流行状态,但防治形势依然严峻。     

麻风治愈者抗PGL-1(IgM)与复发

目的 了解麻风治愈者的抗PGL-1(IgM)与麻风复发的关系,为监测复发提供手段.方法 用NT-P-BSA为抗原,以ELISA法及MLPA法监测麻风治愈者血清中抗PGL-1(IgM)抗体.结果 ELISA法:171例多菌型麻风(MB)治愈者的阳性率为15.79%(27/171),明显高于142例少菌型麻风(PB)治愈者的阳性率3.52%(5/142);MLPA法:171例MB治愈者阳性率为6.25%(22/171),而142例少菌型麻风治愈者均为阴性;ELISA与MIPA两法的阳性者复发率前者为6.25%(2/32),后者为9.09%(2/22),两法阴性者无一例复发.结论 监测麻风治愈者血清中抗PGL-1(IgM)抗体的情况有助于了解复发倾向,对阳性者进行抗复发处理,有利于减少复发或控制复发.     

87例MB麻风联合化疗的疗效观察

绍兴县自1985年4月~1988年4月对87例现症MB(多菌型麻风)病人用WHO(世界卫生组织)的MDT(联合化疗),愈后已监测6~9年。本组共有BB(界线类麻风)8例,BL(界线类偏瘤型)18例,LL(瘤型)61例,男66例,女21例,21~65岁,平均44.6岁,新病人37例,复发50例,病期3~206个月,平均27个月,初治34例,经治53例,曾经治疗8~134个月,平均48个月(4年),用过的药物为DDS(氨苯砜)、RFP(利福平)、TB(氨硫脲),INH(异烟肼)等。使用MDT采用住     

西藏林芝地区2006-2011年麻风病流行趋势分析

目的了解西藏林芝地区2006-2011年麻风病发病情况,为制定防治措施提供依据。方法对2006-2011年麻风病疫情采用描述流行病学方法进行分析。结果 2006-2011年累计报告麻风病例32例,平均发病率为3.08/10万;所辖7个县均有病例报告,以25～44岁青壮年农牧民为主;同村及有接触史传染占59.38%,病例发现平均延迟期为17个月。结论西藏林芝地区目前麻风病处于低流行状态,但距消灭麻风目标差距较大,仍需加强各项麻风病防控工作。     

362例麻风病患者家内接触者发病情况分析

目的:对贵州省麻风病高流行区黔西南州、安顺市2010~2015年新复发病人家内接触者发病情况进行描述及分析,为麻风病防治监测及病人早发现工作提供指导依据。方法:对麻风病患者及家内接触者的基本情况进行调查,采用描述性统计分析方法分析家内接触者发病特点。结果:黔西南州、安顺市2010~2015年新复发麻风患者362例,共344户,其中56户为麻风病多发家庭,有明确家庭内传染源的占同期发现病例数的21.55%;家内感染者发现方式以主动发现为主;多菌型(MB)麻风患者家内接触者中发病明显高于少菌型(PB)麻风患者家内接触者(P0.05)。结论:麻风患者的家内接触者仍是贵州省今后麻风监测中需关注的重点人群;接触者检查和线索调查在麻风高流行地区对早期发现麻风家内感染者仍有其重要意义。     

泉州市1985—2022年麻风病流行病学特征

目的 分析泉州市麻风病流行病学特征,为麻风病的防控提供依据。方法 收集全国麻风病防治管理信息系统(LEPMIS)泉州市上报及历史麻风病例花名册1985—2022年泉州市新复发麻风病例资料进行分析。结果 1985—2022年泉州市报告新发现麻风病例524例,复发病例40例,发现率从1985年的0.47/10万下降到2022年的0.02/10万,患病率从1985年的7.16/10万下降至2022年0.32/10万,1994年后全市患病率均<1/10万,2022年底泉港区患病率>1/10万。各县(市、区)均有病例报告,前3名为惠安县、南安市及晋江市,共占全市71.0%(372例);男女性别比1.9∶1;以20～49岁为主(60.1%,315例),近10年无新发少年儿童麻风病例;总畸残率为17.6%(92/524);型比(MB/MB+PB)为0.6;非户籍病例占比7.6%(40例)。结论 麻风病流行得到控制,长期处于低流行状态,流动人口增加,部分地区患病率较高,说明防控工作应根据实际流行情况继续加强。     

龙岩市1985～2004年麻风病流行特征

目的 了解掌握低流行状态下麻风病的流行特征和规律.方法 对龙岩市1985～2004年麻风病年终报表进行分析.结果 麻风病患病率从1985年的0.128/万下降到2004年的0.031/万,发现率从1985年的0.336/10万,下降到2004年的0.07/10万;新发现麻风病89例,多菌型44例,少菌型45例,型比为0.98:1;畸残率为11.24%;二氨二苯砜(DDS)单疗复发12例,联合化疗(MDT)无病例复发;发现方式主要以皮肤科为主,占50.56%.结论 发病年龄主要在青壮年,无儿童麻风发现.龙岩市麻风流行仍然存在,消灭麻风任重而道远.     

广东顺德1954~2013年麻风复发病例分析

目的研究广东顺德1954²103年用氨苯砜单疗或联合化疗后麻风病患者的复发情况。方法对19542103年用氨苯砜单疗或联合化疗后麻风病患者的复发情况。方法对1954²013年顺德开展麻风病防治工作较完整的麻风个案资料进行分析。结果 19542013年顺德开展麻风病防治工作较完整的麻风个案资料进行分析。结果 1954²013年间顺德累计复发患者64例,累计复发率为4.77%。平均治愈-复发间隔为(131.52±12.64)个月。多菌型的累计复发率高于少菌型的累计复发率(2=76.771,p<0.000 1)。男女的复发率无统计学意义(2=2.349,p=0.125)。利福平600 mg+氧氟沙星400 mg联合化疗治愈患者的复发率为27.27%,高于其他联合化疗方案和氨苯砜单疗的复发率(2=7.974,p=0.034)。结论采用利福平和氧氟沙星联合化疗方案治愈的患者,其复发率远高于其他化疗方案,不建议继续使用和推广。麻风复发有长期危险性,长期监测随访,有助于发现复发患者。     

单用氨苯砜治愈的麻风患者采用联合化疗抗复发的研究

目的：为减少单用氨苯砜（ＤＤＳ）治愈的麻风患者的复发。方法：１９８７～１９９１年用ＷＨＯ－ＭＤＴ方案分批对１９７１～１９８５年ＤＤＳ单疗治愈的部分麻风病人进行６个复治。结果：经６～１０年观察ＭＢ病人经抗复发治疗的２３１例病人的复发率１．３０％（１．７６‰人年）未经抗复发治疗的３２０例病人的复发率，７．５０％（６．５４‰人年）；ＭＢ总复发率４．０４％（４．６‰人年）复治组病人的复发率显著低于后两者（     

Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up

BACKGROUND: Nerve function impairment (NFI) is the key outcome of the pathological processes of infection with Mycobacterium leprae, which can continue after completion of multidrug therapy (MDT) and lead to disability after leprosy patients are released from treatment. The objective of this study was to assess the need for and duration of surveillance of NFI. METHODS: Prospective cohort study of 2664 new leprosy patients in Bangladesh, with an observation period of 36 months in paucibacillary (PB) patients, and 60 months in multibacillary (MB) patients. Incidence rates (IR) were calculated with the number of patients developing NFI, type 1 and type 2 reactions, and silent neuritis for the first time after registration as the numerator, and cumulative person-years at risk (PYAR) as the denominator. Survival curves to the first event of NFI were also calculated. RESULTS: The IR of first event of NFI amongst MB patients was 16.1 per 100 PYAR, with 121/357 (34%) developing NFI during the observation period. Of the 121 with a first event of NFI, 77 (64%) had this within a year after registration, 35 (29%) in the second year, and the remaining 9 (7%) after 2 years. The IR of first event of NFI amongst PB patients was 0.9 per 100 PYAR, with 54/2153 (2.5%) developing NFI during the observation period. Of the 54 with a first event of NFI, 48 (89%) had this within a year after registration, 3 (5.5%) in the second year, and the remaining 3 (5.5%) cases after 2 years. The percentage of PB patients with no NFI at registration surviving without developing NFI during the observation period was 99% and for PB patients with NFI at registration 92%. In MB patients without NFI at registration, the percentage surviving with no NFI during the observation period was 84% and for MB patients with NFI at registration only 36%. CONCLUSION: New episodes of NFI and reactions after registration are common, in particular in MB patients with long-standing NFI at registration. The study highlights the importance of continuing surveillance for NFI of this risk group after registration for 2 years. Active surveillance beyond 2 years is not indicated.     

麻风患者延迟发现对畸残的影响研究

目的了解麻风患者延迟发现对患者残疾的影响,为麻风防治及残疾康复工作提供依据。方法于2013年5~6月由麻风防治人员采用麻风病新发现和复发病例个案报告卡及麻风患者残疾调查表对浙江省2010年1月~2012年12月期间确诊的麻风现症患者和浙江省皮肤病防治研究所的麻风治愈留院者两组人群的发病时间、确诊时间以及残疾情况等方面进行调查,并采用χ2检验和t检验进行统计分析,P〈0.05为差异有统计学意义。结果被调查的两组人群中：麻风治愈留院患者的确诊时间为（69.51±8.36）月,导致的残疾率为96.51%,83例麻风现症患者的确诊时间为（35.96±6.05）月,导致的残疾率为26.51%,麻风患者延迟发现对畸残有明显影响（χ2=87.97,P〈0.01）;麻风现症患者2年内被确诊的比2年以上才确诊的残疾比例低,两组比较差异有统计学意义（χ2=4.40,P〈0.05）;麻风现症患者型别上比较：多菌型（MB）确诊时间比少菌型（PB）长（t=12.14,P〈0.01）,但两者在畸残上比较差异无统计学意义（χ2=0.20,P〉0.05）。结论麻风患者延迟发现对畸残有明显影响;麻风现症患者2年内被确诊的比2年以上才确诊的残疾比例要低。在麻风低流行状态下,应对医务人员进行有效地培训以提高医务人员的麻风诊断水平,减少误诊的发生。     

Elimination of leprosy as a public health problem: progress and prospects.

Leprosy is still an important problem in about 80 countries of Asia, Africa and Latin America, some 2.4 million persons being estimated to have the disease in 1994. The WHO-recommended standard multidrug therapy (MDT) was introduced in the 1980s and has been shown to be effective in combating the disease. Experiences based on many thousands of patients treated with MDT over the past decade indicate extremely low relapse rates (cumulative relapse rates around 1%). By the end of 1993, some 5.6 million patients had been cured, and the global cumulative MDT coverage of registered patients had reached 89%. The number of registered cases fell from 5.4 million in 1985 to 1.7 million in 1994. The significant progress made in leprosy control enabled the World Health Assembly in 1991 to set a goal for eliminating leprosy as a public health problem by the year 2000. One important epidemiological factor is that leprosy is very unevenly distributed: 80% of the problem is confined to only five countries and 92% to just 25 countries. The elimination strategy envisages identifying and treating with MDT a total of about 5 million cases from 1994 to the year 2000. The cost of dealing with these cases has been estimated at US$ 420 million, including US$ 150 million for the drugs.     

Leprosy care. The impact of multiple drug therapy

There are currently an estimated 10-12 million cases of leprosy in the world. Until relatively recently, dapsone was the mainstay of drug therapy against this disease, but it had to be administered for very long periods of time and began to lose effectiveness in the face of growing disease resistance. New standard, multi-drug regimens were therefore recommended by WHO in 1982 and have since become the standard minimum necessary treatment in leprosy control programs. Multiple drug therapy (MDT), if administered early enough, can cure leprosy before deformity develops. Its cost and complexity, however, impede its widespread dissemination where needed. Much of rural Africa especially suffers from a lack of MDT due to financial constraints, geographic isolation, transport difficulties, and poor healthcare infrastructure. Dr, William Philip of the United Kingdom Aberdeen Royal Infirmary describes the introduction of MDT into and throughout rural northwestern Uganda over the period 1986-90. The introduction of MDT in West Nile has made a positive impact against leprosy. Most patients have been released from treatment or will be released soon after completing their regimes, so that only new cases will be receiving drug therapy. This large drop in case load will allow greater effort to be placed upon early case detection and treatment. MDT over time will reduce the number of patients needing drug therapy and leave only few disabled patients after a few decades. In so doing, MDT seems to be the approach needed to control and eventually eradicate leprosy. It is hoped that this program experience will help guide program implementation in other areas where MDT has yet to be introduced.     

冕宁县麻风病防治与综合卫生服务相结合试点分析

目的探索新形势下如何充分利用现有卫生资源开展麻风病防治早期发现与治疗患者,预防畸残。方法通过对现有乡、村医生进行麻风病防治和技能培训,普及麻风病知识。结果知晓率：项目开展前群众为26％,学生为30％,项目开展后群众达到67％,学生达到90％。5年共计新发现25例（多菌型19例,少菌型6例）,14岁以下儿童1例。康复工作：为48人作了69例矫形手术。结论通过对基层医务人员麻风病防治知识培训,提高了的诊断技能,患者得到及时发现与治疗。     

Leprosy: an urgent need to step up use of MDT in Africa

10-12 million people in the world have leprosy. India claims about 4 million of these cases. Overall at least 20% of the cases are children. In the 1940s, dapsone was the only drug used to treat leprosy. By the early 1970s, dapsone did not perform as expected and Mycobacterium leprae were beginning to exhibit resistance to dapsone. In 1982, WHO published results of its study which recommended fixed and relatively short duration regimens of multiple drug therapy (MDT) for all people with leprosy. It also listed recommendations on diagnosis, classification, and distribution of patients to either pauci or multibacillary groups. MDT depends on what type of leprosy patients have. For example, patients with multibacillary leprosy receive rifampicin, clofazimine, and dapsone whereas those with paucibacillary leprosy receive only rifampicin. In many African countries, however, MDT is not used. Yet cases of leprosy exist in 94% of Africa's countries. Moreover 37% have highly prevalent leprosy and the lowest percentage of patients on MDT (18% vs. world average of 56%). In fact, Nigeria is included in the group of 5 countries with 84% of all cases. Until the various countries in Africa can satisfy the ideal requirements for establishing a MDT program, they should begin MDT at least on a small scale. They do need, however, an adequate supply of the drugs. The other requirements include a good plan of action, laboratory facilities, transport, and referral centers. If the period of time needed to meet these requirements is long, then physicians should conduct pre MDT screenings to diagnose cases and determine who needs chemotherapy. The best way to diagnose cases is from clinical experience and paying particular attention to dermatological and neurological findings. Early identification is needed since leprosy cases are stigmatized. This article includes MDT dosages in adults and children.     

用巢式聚合酶链式反应从全血扩增麻风菌特异片段提高麻风病确诊率

目的用巢式聚合酶链式反应(Nested-PCR)检测全血中麻风菌特异片段,以提高麻风病诊断水平。方法收集多菌型(multibacillary leprosy,MB)、少菌型(paucibacillary leprosy,PB)麻风病患者、其家庭内接触者以及麻风病流行区、非流行区的正常人全血和血清样本,建立巢式PCR,扩增麻风菌重复序列的特异片段,PCR阳性产物直接测序鉴定扩增片段的特异性。结果在35例MB患者中巢式PCR有34例阳性;26例PB患者中19例阳性;23例家庭内接触者中2例阳性。流行区和非流行区正常人中未见阳性。此结果与血清学结果进行比较,发现血清学检测MB患者阳性率稍高于巢式PCR;值得注意的是,对PB患者中细菌密度指数(BI)为阴性者,巢式PCR阳性检测率高达78.57%。结论巢式PCR对于麻风病MB患者的诊断敏感性不亚于血清学抗体诊断,但可提高麻风病特别是对PB患者诊断的敏感性;对高危人群尤其是家庭内接触者的监测有较大的实用价值。