麻风联合化疗中发生麻风反应43例临床分析

Clinical analysis of 43 cases with leprosy reaction in leprosy multidrug therapy

目的:了解联合化疗(MDT)中发生麻风反应患者的临床特征及相关因素,为麻风防治工作提供依据。方法:收集2006-2020年在全国麻风病防治管理信息系统(LEPMIS)中登记并终审通过的山东省所有完成MDT且在此期间发生麻风反应的患者的相关信息,应用SPSS 23.0软件进行一般描述性统计分析和非参数Spearman秩相关系数检验,评估MDT中麻风反应特点及相关因素。结果:2006-2020年完成MDT治疗的患者314例,期间43例发生麻风反应(13.7%)。43例患者中新发病例39例(90.7%),复发病例4例(9.3%)。其中BT 3例(7.0%),BL 14例(32.5%),LL 26例(60.5%)。43例患者MDT中共发生麻风反应69例次,平均每例1.6次,15例(34.9%)患者至少发生过两次反应。9例(20.9%)发生I型反应,27例(62.8%)发生II型反应,3例(7.0%)发生混合型反应。26例(60.4%)患者首次反应发生在MDT的前8个月内。Spearman分析显示MDT中麻风反应发生次数与文化程度(r_(s)=0.383,P=0.011)成正相关,与麻风诊断时间(rs=-0.323,P=0.035)呈负相关。结论:MDT中麻风反应的发生率较高。反应多见于LL,可反复发生;II型反应较常见,多发生于MDT的前8个月内。反应发生次数与文化程度和诊断时间相关。

Objective:To investigate the clinical characteristics and related factors of patients with leprosy reactions during multidrug therapy(MDT),and to provide basis for leprosy prevention and treatment.Methods:Relevant information of leprosy patients registered in the LEPMIS in Shandong Province who completed MDT and suffered from leprosy reactions from 2006 to 2020,were collected.General descriptive and Spearman’s correlation statistical analysis were used to evaluate the characteristics of leprosy reaction and its correlation with relevant factors in SPSS 23.0.Results:314 patients completed MDT from 2006 to 2020,of whom 43 had leprosy reaction(13.7%),including 39(90.7%)new cases and 4(9.3%)relapsed cases,3 BT(7.0%),14 BL(32.5%),and 26 LL(60.5%).A total of 69 times leprosy reaction occurred in 43 patients during MDT,with an average of 1.6 times per case,15(34.9%)patients suffered from at least twice of reaction.Of 40 cases,type 1 reaction occurred in 9(20.9%),type 2 reaction occurred in 27(62.8%)and two types of reactions both occurred in 3 cases(7.0%).The first time reaction occurred during the first 8 months of MDT in 26 cases(60.4%).Spearman analysis showed that the times of leprosy reactions during MDT was positively correlated with education level(r_(s)=0.383,P=0.011)and negatively correlated with the time of confirmed diagnosis(r_(s)=-0.323,P=0.035).Conclusion:The incidence of leprosy reactions in patients with leprosy during MDT is high.Leprosy reactions are more common in LL patients and can occur repeatedly.Type 2 reaction is more common than type 1 reaction in MDT patients,which mostly occurs within the first 8 months of MDT.The times of reaction is related to education level and confirmed time of diagnosis.