111例I型麻风反应的临床分析

Clinical analysis of 111 leprosy patients with type I reaction

目的 : 探讨WHO/MDT方案治疗中I型麻风反应的发生率、临床特点及治疗。方法 : 对111例I型麻风反应的发生率、与型别关系、临床表现、反应出现时间及持续时间进行分析。结果 : 20 0 4例麻风患者中出现I型反应者 111例 ,占 5 .5 4% ,其中界线类 (BT、BB、BL)麻风占反应病人总数的77.49%。仅有皮损者 4例 ,占 3.0 6 % ,皮损伴神经损伤者 93例 ,占 83.78% ,仅神经损伤者 14例 ,占12 .6 1%。疗前、疗中出现反应者 10 2例 ,占 91.89% ,MDT疗后 1年内出现反应者 5 8例 ,占 5 2 .2 5 % ,持续 6月左右者 6 9例 ,占 6 2 .16 %。结论 : 麻风患者采用MDT治疗的I型麻风反应发生率为 5 .5 4% ,多在疗后 1年内初治界线类麻风产生 ,易引起神经损伤且持续时间长 ,要及早采用皮质类固醇治疗 。

Objective:To investigate the incidence, clinical features and management of type I reaction (RR) in leprosy patients treated with WHO/MDT regimen.Methods:Incidence, relation with classification, clinical feaetures , time of onset and duration of RR of 111 leprosy patients were analyzed. Results:Out of 2 004 leprosy patients studied, 111 cases (5.54%) developed RR, including 4 (3.60%) reactions characterized by episodes with skin lesions only, 93 (83.78%) with both skin lesions and nerve damage, and 14 (12.61%) with nerve impairments only. Among the 111 cases with RR, there was a predominance of borderline leprosy patients (BT, BB and BL),accounting for 77.49%. One hundred and two patients (91.89%) experienced RR before or during MDT. In 58 cases (52.25%) RR occurred in the first year of treatment and 69 reactions (62.16%) persisted around 6 months.Conclusions:The incidence of type I reaction in MDTtreated leprosy patients was 5.54%, and the highest risk was during the first year of treatment in previously untreated borderline patients. Nerve impairments were frequently caused by type I reaction and generally persisted for long time.Corticosteroid therapy should be initiated as early as possible in order to prevent deformity. [