麻风病研究进展与海南省防治现状

Research progress of leprosy and its control status in Hainan Province

麻风病作为一种重要的被忽视的热带病(neglected tropical diseases,NTDs),对患者躯体、心理、家庭和社会具有巨大影响。笔者就麻风病流行病学、遗传因素、免疫机制、诊断及治疗进展进行简述,并介绍国家防治政策变迁和海南省防治历程,以期提高广大医务工作者的临床认识。WHO全球麻风病疫情年度报告数据显示,全球报告新发病例数和发病率呈逐年下降趋势。我国麻风病疫情继续保持整体低流行状态,但长期低流行状态和疫情分布广泛且不均衡的特征仍然给防治工作带来挑战。麻风病发病机制主要与皮肤屏障、免疫缺陷、相关信号通路相关。血清学检测、细胞因子及微小RNA(micro RNA)标记物均可应用于辅助麻风病的早期诊断,同时有助于不同型别麻风病的区分、预测麻风反应、评估疗效及监测家庭接触者。麻风病的主要治疗方案采用WHO推荐的利福平、氨苯砜和氯法齐明等药物进行联合化疗。目前麻风病主要防治策略为早发现、早诊断、早治疗,控制传染源,保护健康人群,预防畸残发生,提高愈后生活质量。现阶段,海南省乃至全国处于低流行状态,但医务人员仍需要提高防范意识,减少其发病率,争取早日实现“零麻风”目标。

Leprosy,as an important neglected tropical disease(NTDs),has a tremendous impact on the patients’body and psychology,families and society.In this paper,we reviewed the progress of epidemiology,genetic factors,immune mechanisms,diagnosis and treatment of leprosy,and introduced the changes of national prevention and control policies and the prevention and control process of Hainan Province,so as to improve the clinical understanding among healthcare professionals.According to the World Health Organization's(WHO)global annual leprosy situation report data,the number of new cases and the incidence rate of leprosy have been showing a downward trend worldwide.In China,the epidemic situation of leprosy remains in an overall low-endemic state.However,the long-standing low-endemic status of leprosy and its wide and uneven distribution pose challenges to the prevention and control of leprosy.The pathogenesis of leprosy is mainly related to skin barrier,immune deficiency,and related signaling pathways.Serological testing,cytokines,and microRNA markers can all be used to assist in the early diagnosis of leprosy,while also helping to distinguish different types of leprosy,predict leprosy reactions,evaluate efficacy,and monitor family contacts.The main treatment plan for leprosy involves combination chemotherapy with drugs recommended by the WHO,such as rifampicin,dapsone,clofazimine and other drugs.Currently,the main prevention and treatment strategies for leprosy are early detection,early diagnosis and early treatment,controlling the source of infection,protecting the healthy population,preventing the occurrence of deformity,and improving the quality of life after recovery.At present,Hainan Province as well as the whole country is in a low-epidemic state,but healthcare professionals still need to improve their awareness of prevention,reduce their incidence rate,and strive to achieve the goal of"zero leprosy"as soon as possible.