统一联合化疗和常规联合化疗后多菌型麻风患者的细菌指数变化和麻风反应率比较

中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (8): 553-556.

统一联合化疗和常规联合化疗后多菌型麻风患者的细菌指数变化和麻风反应率比较

余美文¹,²,沈建平³,严良斌¹,⁴,周敏¹,²,牟鸿江¹,⁵,包夏⁵,杨荣德¹,⁶,王娟⁶

1.
2. 中国医学科学院皮肤病研究所
3. 南京中国医学科学院北京协和医学院皮肤病研究所
4. 中医学科学院皮肤病研究所
5. 贵州省疾病预防控制中心
6. 云南省文山州皮肤病防治所

收稿日期:2011-09-07 修回日期:2012-02-22 出版日期:2012-08-15 发布日期:2012-08-01
通讯作者: 沈建平 E-mail:jianping_shen2@yahoo.com.cn

Efficacy comparison of uniform versus routine multidrug therapy for the treatment of multi-bacillary leprosy patients based on bacterial index and leprosy reactions

Received:2011-09-07 Revised:2012-02-22 Online:2012-08-15 Published:2012-08-01

摘要/Abstract

摘要：

目的评价统一联合化疗（UMDT）后多菌型麻风患者的细菌指数变化和麻风反应频率，并与常规联合化疗（RMDT）后多菌型患者的结果比较。方法 2003—2005年在贵州3个地区和云南1个地区收集新麻风患者，给予6个月WHO多菌型联合化疗方案。对照组为同一地区接受2年RMDT的多菌型麻风患者，所有患者接受每年1次临床随访和细菌检查。对两组患者的细菌学数据和临床麻风反应频率进行比较。结果共166例各种类型麻风患者接受UMDT，其中114例为疗前细菌检查阳性的多菌型患者，有83例已经随访42个月。同一地区新登记疗前查菌阳性并接受RMDT的多菌型麻风患者170例，其中149例具有48个月完整细菌资料。接受UMDT的83例患者从治疗后到42个月，平均细菌指数从疗前2.84下降到0.33，同时61例患者（73.55%）细菌指数阴转。接受RMDT的149例多菌型患者，在开始治疗后到48个月，平均细菌指数从疗前的2.55下降到0.26，其中有115例患者（77.2%）细菌指数阴转，两组平均细菌指数变化之间差异无统计学意义（t = 0.77，P > 0.05），细菌指数阴转率差异无统计学意义（?字2 = 0.40，P > 0.05）。UMDT组有13例患者（14.6%）在观察期发生麻风Ⅰ型反应，而RMDT组只有5例（3.4%）在观察期发生麻风Ⅰ型反应，两组间差异有统计学意义（?字2 = 10.08，P < 0.01）。结论在观察期末，UMDT组和RMDT组在细菌指数变化和阴转率上差异无统计学意义。UMDT组Ⅰ型反应发生率高于RMDT组，其原因值得进一步研究。

关键词: 麻风统一联合化疗细菌指数麻风反应

Abstract:

Objective To compare the efficacy of uniform multi-drug therapy （UMDT） versus routine multi-drug therapy （RMDT） for the treatment of multi-bacillary （MB） leprosy patients based on bacterial index changes and frequencies of leprosy reaction. Methods This study recruited newly diagnosed leprosy patients after taking informed consent in three districts of Guizhou province as well as in one district of Yunnan province from November 2003 to June 2005. The patients received 6-month UMDT or 2-year RMDT. Clinical follow up and bacterial reexamination were carried out once a year. Changes of bacterial index （BI） and frequencies of leprosy reaction were compared between the patients receiving RMDT and UMDT. Results A total of 166 patients received UMDT and 170 received RMDT in this study. Among the UMDT-treated patients, 114 were skin smear positive, and 83 had been followed up for 42 months; of the RMDT-treated patients, 149 underwent all the bacterial examinations during a 48-month follow up. The mean bacterial index decreased from 2.84 before treatment to 0.33 at the end of the 42-month follow up in the 83 patients, and from 2.55 to 0.26 at the end of the 48-month follow up in the 149 patients, with no significant difference in the changes of bacterial index between the two groups （t = 0.77, P > 0.05）. Bacterial index became negative in 73.5% （61/83） of the UMDT-treated patients and in 77.2% （115/149） of the RMDT-treated patients （?字2 = 0.40, P > 0.05）at the end of follow up. During the follow up peroid, the incidence of type 1 leprosy reaction was 14.6% （13/89） in the UMDT group, significantly higher than that in the RMDT group （3.4% （5/149）, ?字2 = 10.08, P < 0.01）. Conclusions There is no significant difference in mean bacterial index changes and bacterial clearance rate during the follow up peroid between UMDT- and RMDT-treated patients. The incidence of type 1 leprosy reaction is higher in the UMDT group than in the RMDT group, and further investigation is needed to clarify the mechanisms underlying the phenomenon.

Key words: Leprosy Uniform multidrug therapy Bacteriological index Leprosy reaction

余美文沈建平严良斌周敏牟鸿江包夏杨荣德王娟. 统一联合化疗和常规联合化疗后多菌型麻风患者的细菌指数变化和麻风反应率比较[J]. 中华皮肤科杂志, 2012, 45(8): 553-556.

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