麻风患者166例统一联合化疗后2年随访

A 2-year follow-up study on 166 leprosy patients treated with uniform multidrug therapy

目的探讨6个月麻风统一联合化疗方案对各型麻风患者的疗效。方法对166例各型麻风患者采取世界卫生组织多菌型方案治疗6个月，观察临床和细菌学方面的疗效。结果在166例患者中因各种原因退出31例，完成治疗并随访2年的患者135例。135例疗前查菌阴性者为45例（33．3％），其余90例患者细菌指数从0．1～6．0不等，细菌指数疗前平均为2．91±1．45，在停止治疗第2年末，45例细菌阴性患者显示总的皮损消退和改善率达到93．3％。神经体征改善率达80．O％。在90例查菌阳性患者中，皮肤损害消退和改善率达95．6％，神经改善率达77．8％。疗前细菌阳性的90例患者中有49例患者细菌阴转，占54．4％，平均细菌指数降低为0．66±0．99。从开始治疗后的2．5年中，平均每年下降0．9。在完成治疗停药随访满2年的135例患者中有25例发生麻风反应。其中Ⅰ型和Ⅱ型反应分别为13例和12例。在166例患者中，有1例多菌型患者在停止治疗后13个月复发。结论统一联合化疗的近期疗效与常规MDT方案治疗2年的结果相似，其反应发生率差异以及远期复发率尚待观察。

Objective To assess the efficacy of 6-month uniform muhidrug therapy in various types of leprosy. Methods A field trial was conducted among 166 patients with different types of leprosy. All patients were treated with uniform muhidrug therapy for 6 months, then followed up for 2 years. Clinical and bacteriological improvements were evaluated. Results Among the 166 patients, 31 dropped out due to various reasons, and 135 completed the 6-month treatment and 2-year follow-up. Among the 135 patients, 45 （33.3%） were skin smear negative, and the other smear-positive 90 had an average bacterial index （BI） of 2.91 ± 1.45 （range： 0.1 - 6.0） before treatment. At the end of the 2-year follow-up, the 45 skin smear-negative patients showed 93.3% improvement in skin lesions and 80.0% improvement in nerve impairments, and the smear-positive 90 patients showed 95.6% improvements in skin lesions and 77.8% improvement in nerve impairments. Skin smear turned negative in 49 （54.4%） out of the smear-positive 90 patients with the average BI declining to 0.66 ± 0.99. The annual decrease in BI reached 0.9 during the first 2.5 years after the beginning of treatment. Twenty-five patients developed leprosy reaction during the follow-up, including 13 cases of type Ⅰ leprosy reaction and 12 cases of type Ⅱ leprosy reaction. Relapse was noted in 1 patient with muhibacillary leprosy 13 months after the termination of treatment. Conclusions The short-term efficacy of uniform muhidrug therapy is similar to that of 2-year treatment with routine muhidrug therapy. However, further studies are required to survey the incidence of leprosy reaction and relapse in patients treated with uniform muhidrng therapy.