麻风患者完成联合化疗后的临床与病理改变  

Clinical and Pathological Features of Leprosy after Multidrug Therapy

作　　者：王金容 杨雪松[1] 叶建洲[1] 李文华[2] 唐安平 周晓鸿[2] WANG Jinrong;YANG Xuesong;YE Jianzhou;LI Wenhua;TANG Anping;ZHOU Xiaohong(Yunnan Provincial Hospital of Traditional Chinese Medicine,Yunnan Dermatological Hospital of Traditional Chinese Medicine,Kunming 650021,China;The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Anning Center for Disease Control and Prevention,Kunming 650300,China)

机构地区：[1]云南省中医医院,云南省中医皮肤病专科医院,云南昆明650021 [2]昆明医科大学第二附属医院,云南昆明650101 [3]安宁市疾病预防控制中心,云南昆明650300

出　　处：《中国皮肤性病学杂志》2023年第5期542-545,共4页The Chinese Journal of Dermatovenereology

基　　金：云南省冯素英专家工作站(202105AF150035);2022年云南省科技厅中医联合专项-青年项目(202101AZ070001-289)。

摘　　要：目的观察完成治疗后的麻风患者临床与组织病理变化,评估治愈标准,提高皮肤科医生长期随访意识。方法收集在麻风防治专业机构接受联合化疗(MDT)方案规则服药结束至本科复查的麻风患者临床资料,对其组织蜡块切片后做HE染色和抗酸染色,观察病理特点;根据收集的临床及病理资料进行回顾性分析。结果收集到19例治疗后具有完整资料的麻风患者,11例(57.89%)达到临床治愈标准,临床上均无活动性麻风皮损,部分留有色沉、色减或鱼鳞病样改变。11例治愈者中,5例(45.45%)组织病理呈非特异性炎症改变,6例(54.55%)呈麻风消退后期改变,肉芽肿较小,泡沫细胞处于退行期;2例(18.18%)组织抗酸染色见碎裂状、颗粒状麻风杆菌。8例患者(42.11%,8/19)未达临床治愈标准,皮损部分未消退,以色减斑、色沉斑、暗红斑为主,4例(50.00%,4/8)存在Ⅱ型麻风反应,伴红斑、结节、脓疱;病理上均有肉芽肿形成,但肉芽肿较小,肉芽肿中的泡沫细胞处于退行期;组织抗酸染色见完整麻风杆菌,均为多菌型。结论麻风患者通过MDT治疗方案服药结束后,仍需复查组织病理及抗酸染色评估是否达到治愈。部分多菌型麻风患者在疗程结束时不能达到临床治愈标准,对于完成治疗后仍然伴有严重麻风反应的患者可能需要延长治疗疗程;结束治疗后需长期监测,及时发现复发患者。Objective To observe the clinical and histopathological changes of leprosy patients after treatment,evaluate the cure criteria,and improve the awareness of dermatologists in long-term follow-up.Methods Clinical data of leprosy patients who received multidrug therapy(MDT)regimen in specialized institutions for leprosy prevention and control were collected from the end of regular medication to the review of our department.Wax sections of their tissues were stained with HE and acid-fast staining to observe the pathological characteristics.The collected clinical and pathological data were retrospectively analyzed.Results Among the 19 cases of leprosy with complete data collected after treatment,57.89%(11/19)reached the clinical cure standard,there was no active leprosy lesions in clinical,some of them had pigmentation,hypochromia or ichthyosis changes.Pathologically,45.45%(5/11)showed non-specific inflammatory changes,and 54.55%(6/11)showed late changes of leprosy regression,which granuloma was small,and foam cells were in the regression stage.The acid-fast staining of 18.18%(2/11)tissues showed fragmentary and granular leprae.Eight patients(42.11%)did not reach the clinical cure standard,the skin lesions did not subside,and the lesions were mainly reduced spots,pigmentation spots and dark erythema.Four patients(50.00%,4/8)had typeⅡleprosy reaction,accompanied by erythema,nodules and pustules.Pathologically,granulomas were formed,but the granulomas were small,and the foam cells in the granulomas were in the stage of degeneration.Acid fast staining of the tissue showed intact Leprae,which were all polybacteria.Conclusion After treatment with MDT,histopathology and acid-fast staining should be reviewed to assess whether leprosy patients are cured.Some patients with multibacterial leprosy connot reach the clinical cure standard at the end of the course of treatment.For patients who still have severe leper reaction after the completion of treatment,may need to prolong the treatment course.Long-term monitoring is requir

关 键 词：麻风 组织病理 联合化疗 

分 类 号：R755[医药卫生—皮肤病学与性病学]