联合化疗中麻风反应的临床特征及糖皮质激素治疗的效果分析  

Clinical features of leprosy reaction in the period of MDT and the therapeutic effect of glucocorticoids

作　　者：张壤之 李红星[1] 王景权[2] 严良斌 

机构地区：[1]江苏省东台市疾病预防控制中心,江苏东台224200 [2]浙江省皮肤病防治研究所,浙江德清313200 [3]中国CDC麻风病控制中心,江苏南京210042

出　　处：《中国皮肤性病学杂志》2012年第1期30-32,共3页The Chinese Journal of Dermatovenereology

摘　　要：目的了解麻风联合化疗时麻风反应的发生情况,评价糖皮质激素对麻风反应的治疗效果。方法对本市1986-2005年采用联合化疗方案治疗后达到临床治愈的新发及复发麻风病人的临床资料进行回顾性分析。结果 63例进行联合化疗的麻风患者,有37例曾经发生72例次麻风反应,23例发生Ⅰ型麻风反应34例次,15例发生Ⅱ型麻风反应31例次,7例发生混合型麻风反应7例次;且73.53%麻风反应发生在联合化疗1年内,Ⅱ型麻风反应均出现在联合化疗1年后,但是混合型麻风反应出现时间不一。麻风反应以皮肤和周围神经症状为主要表现,其中Ⅰ型、Ⅱ型和混合型麻风反应发生时有皮肤症状者分别占64.71%,100%和100%,有神经受累者分别占100%,61.29%和42.86%。治愈24例次,显效19例次,好转21例次,无效0例次,恶化8例次,有效率为59.72%。糖皮质激素治疗后25例次(34.72%)出现胃部不适,16例次出现满月脸多血质,7例次出现骨质疏松症样疼痛,但是均未影响治疗。结论麻风联合化疗患者麻风反应高发,神经受累相对较多,激素治疗麻风反应有一定的效果,但治疗方案仍有改进的空间。Objective To explore the situation of leprosy reaction occurred in the period of multidrug threapy（MDT） and evaluate the therapeutic effect of glucocorticoids. Methods The clinical data of the new and relapse leprosy cases, who were treated with MDT till cure during the period 1986 - 2005, were retrospectively ana- lyzed. Results Seventy-two episodes of leprosy reaction occurred in 37 out of 63 cases, in which 34 epi- sodes of type 1 reaction happened in 23 cases, 31 episodes of type 2 reaction in 15 cases, and 7 episodes of mixture in 7 cases,respectively. 73.53% of type 1 reactions occurred in less than 1 year of MDT, and all type 2 reactions in more than 1 year of MDT, but the type of mixed reactions in different times of MDT. Lep- rosy reactions were characterized by skin lesions, with presentation rates of 64.71% （Type 1 ） , 100% （type 2） and 100% （mixture）, and peripheral nerves involvement,with those of 100% （Type 1 ）, 61.29% （type 2） and 42.86% （mixture）, respectively. Among 72 episodes, 24 cured, 19 excellent, 21 improved, 0 invalid, 8 deteriorated,with a total effective rate of 59.72%. Glucocorticosteroides treatment caused upset stomach in 25 cases （34.72%）, moonshaped and bloody face in 16 cases （22.22%） , osteoporosis pain in 7 cases （9.72%） , which were mild and did not influence the treatment. Conclusion Leprosy reaction has high prevalence in MDT and dominates relatively with nerve involvement. Glucocorticosteroides has certain remedial effect to leprosy reaction, but the treatment regimen should be improved to some extent.

关 键 词：麻风反应 神经损害 联合化疗 

分 类 号：R755[医药卫生—皮肤病学与性病学]