1959—2020年米易县麻风病流行特点及畸残因素分析

Analysis on epidemic characteristics of leprosy and disability related factors in Miyi County from 1959 to 2020

目的 对1959—2020年米易县麻风病流行特点及其畸残影响因素进行分析,为下一步指导麻风病防治提供依据。方法 收集1959—2020年米易县麻风病病例防治专项资料、统计年报表、麻风病个人档案资料、《米易县麻风志》、《米易县康复院志》、《米易年鉴》和全国麻风病防治管理信息系统(LEPMIS)的信息,使用SPSS 23.0软件对病例的一般情况和治疗分型、诊断分型、性别、年龄及职业等有关因素进行卡方检验和多因素Logistic回归分析。结果 1959—2020年米易县共报告麻风病病例620例,年均发病率以1959—1968年最高,达23.25/10万;多菌型病例占51.13%,诊断分型多为TT型(39.52%)和LL型(37.10%);2级畸残率为34.19%;男性445例(71.77%);职业以农民(91.77%)为主,汉族(85.97%)多于彝族,文盲或半文盲占72.26%。卡方检验结果显示畸残的影响因素包括延迟期长短(χ^(2)=33.958,P<0.001)、发病年龄(χ^(2)=123.157,P<0.001)、确诊时反应程度(χ^(2)=99.856,P<0.001),将上述变量引入二元Logistic回归,结果提示畸残的影响因素包括诊断延迟2年以上(OR=2.217,95%CI:1.482~3.318)、确诊时有麻风反应(OR=4.477,95%CI:1.310~15.303)以及不明是否有反应(OR=33.32,95%CI:14.289~77.702)。结论 导致麻风病患者发生畸残的因素较为复杂,主要因素有延迟期长短和确诊时反应程度等。米易县麻风病防治工作取得了显著成效,但今后一段时期的工作重点仍需坚持早发现、早诊断、早治疗的防治策略,积极开展线索调查和走访入户工作,加强对皮肤科和乡村医生的培训,开展可疑症状监测和健康教育。

Objective To analyze the epidemiological characteristics of leprosy and its disability related factors in Miyi County from 1959 to 2020,so as to provide a basis for the next step to guide prevention and treatment of leprosy.Methods The special data were collected on the prevention and treatment of leprosy cases in Miyi County from 1959 to 2020,the statistical annual report,the personal file data of leprosy,the information of“Leprosy Records of Miyi County”,“Rehabilitation Hospital Records of Miyi County”,“Miyi Yearbook”and“National Leprosy Prevention and Control Management Information System(LEPMIS)”,and SPSS 23.0 was used to perform chi-square test and multivariate Logistic regression analysis on the general situation of cases and related factors such as treatment classification, diagnostic classification, gender, age, occupation and so on.Results A total of 620 leprosy cases from 1959 to 2020 were reported with the highest annualincidence of 23.25/105 in 1959 to 1968;And its diagnostic classification was mostly TT type(39.52%) and LL type (37.10%);The rate of grade 2 disability was 34.19%;445 cases (71.77%)were male;The majority of occupations were peasants (91.77%);Han nationality (85.97%) wasmore than Yi nationality;72.26% were illiterate or semi- illiterate. The results of chi- square testshowed that the related factors for the disability of leprosy were the length of delayed diagnosis(χ^(2)=33.958, P<0.001), age of onset (χ^(2)=123.157, P<0.001), degree of leprosy reaction (χ^(2)=99.856,P<0.001) . Add the above variables into binary logistic regression, and the situation inwhich diagnosis was delayed by more than 2 years (OR=2.217, 95%CI: 1.482-3.318), it hadleprosy reaction at diagnosis (OR=4.477, 95%CI: 1.310-15.303), and it was unclear whetherthere was reaction at diagnosis (OR=33.32,95%CI:14.289-77.702) were still associated with thedisability. Conclusions The factors leading to the occurrence of disability in leprosy patients arecomplex. The main factors include delayed diagnosis and the degree of leprosy reaction.Theprevention and treatment of leprosy in Miyi County has achieved remarkable results, but we stillshould adhering to the prevention and treatment strategy of early detection, early diagnosis andearly treatment, actively carrying out clues investigation and household visits, the training ofdermatologists and rural doctors should be strengthen, and carrying out suspicious symptommonitoring and health education are still the huge focus of work in the coming period.