2011-2020年山东省麻风现症病例管理方式改革效果评价

Assessment of leprosy registered active cases management measures in Shandong Province during 2011-2020

目的:以麻风反应、神经炎、药物不良反应的发现率和救治率,以及现症病例新畸残发生率为评价指标,评价我省现症病例管理措施的成效。方法:近十年来,我省采取常规麻风现症病例管理措施有人员培训、耐药监测、病例管理信息化、工作督导和技术指导等,我省的特色管理措施包括氨苯砜(DDS)超敏综合征(DHS)精准预防、病例省级管理、麻风反应神经炎和药物不良反应的省级确认与救治。结果:2011-2020年期间,我省共有麻风现症病例328例,失访20例,死亡26例,外迁2例,判愈224例,截止到2020年底,尚有现症患者56例。全省共救治麻风反应312人次,神经炎106人次,药物不良反应8例,救治率均达到100%。规划期间,共有新发及重症麻风现症患者41例接受了住院治疗,救治神经炎34人次,麻风反应41人次。通过实施现症病例管理措施,我省麻风现症病例的麻风反应、神经炎和药物不良反应早期发现和及时救治率达到100%。联合化疗期间新畸残发生率为1.3%,明显低于国家规划不超过10%的控制目标。山东省皮防所首先成功定位了DHS的风险位点,为2015年以来全国21省份的3197例新发麻风病例进行疗前监测,阳性者避免服用DDS,阴性者服用DDS,均未发生DDS超敏综合征。结论:我省通过现症病例统一管理,麻风反应、神经炎和药物不良反应的省级确认与救治,以及DDS超敏综合征精准预防等措施,最大程度减少了现症病例致残和致死发生。

Objective:To assess the efficiency of registered reactive case management measures,the proporeion diagnosis and treatment of leprosy reaction,neuritis and adverse drug reactions,as well as the occurrence of new G2D among patients receiving MDT were analyzed.Methods:Traditional case management measures adopted include drug resistance monitoring,medical file electronization,supervision and technical guidance and personnel training.Specific measures of our province concise of follow-up at provincial level,provincial confirmation and management of leprosy reaction,neuritis and adverse drug reactions,precise prophylaxis of dapsone(DDS)hypersensitivity syndrome(DHS).The effectiveness of case management measures was evaluated by the detection and treatment proporeion of leprosy reaction,neuritis and adverse drug reaction and occurrence of new visible deformities during multi-drug therapy(MDT).Results:From 2011 to 2020,there were 328 registered active cases in Shandong Province,including 20 cases who were lost to follow up,26 cases of death before cured,2 emigrations,and 224 cases of recovery.By the end of 2020,there were still 56 active cases.All of the 312 episodes of leprosy reactions,106 episodes of neuritis and 8 adverse drug reaction cases were diagnosed and treated during 2011-2020,the diagnosis and treatment rate reaching 100%.A total of 41 cases of newly diagnosed and severe active cases were admitted,including 34 episodes of neuritis and 41 episodes of leprosy reaction.The incidence of new deformity during MDT was 1.3%,much lower than the control target of no more than 10%in the national plan.Zhang Furen from Shandong Provincial Institute of Dermatology and Venerology identified HLA-B*13:01 as the risk site for DHS.All of those with positive HLA-B*13:01 screening results before MDT succeeded in escaping DHS by avoiding taking DDS.Conclusion:Through the unified management of current cases,diagnosis and treatment of leprosy reaction,neuritis and adverse drug reactions,and precise prevention of DDS hypersensitivity syndrome,the incidence of disability and death of current cases have been greatly reduced.