Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

BackgroundPrevious studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.Methodology/Principal findingsWe performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; pConclusions/SignificanceUS nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.

研究背景
既往研究证实，麻风病联合化疗（MDT, Multi-Drug Therapy）无法阻断神经功能损害的进展。目前尚无前瞻性研究探讨麻风病患者接受治疗后神经解剖学异常的演变规律。本研究纳入麻风病患者，旨在明确其接受MDT治疗后神经超声（US, Ultrasonography）异常的演变情况，以及治疗后不良预后的危险因素。
研究方法与主要结果
本研究对9例少菌型（PB, Paucibacillary）麻风病患者及64例多菌型（MB, Multibacillary）麻风病患者，在接受MDT治疗前后分别开展尺神经（U）、正中神经（M）与腓总神经（CF）的双侧超声检查。研究期间共有42例患者出现麻风病反应（包括1型反应、2型反应及急性神经炎）。我们对神经最大横截面积（CSA, Cross-Sectional Areas）、回声强度及神经内多普勒信号进行了分析。不良预后定义为：治疗后神经横截面积超出正常参考范围，且较基线值降幅不足30%（尺神经、正中神经）或40%（腓总神经）；或治疗后超声检查仍存在回声异常或神经内多普勒信号。研究结果显示，少菌型患者及未出现麻风病反应的患者，其腓总神经的横截面积存在显著升高；而多菌型患者及出现麻风病反应的患者，其部分神经的横截面积在治疗后出现下降（p<0.05）；且出现反应的患者不良预后发生率为66.7%，显著高于未出现反应患者的38.7%（p<0.05）。
研究结论与意义
无论麻风病分型如何，或是否存在麻风病反应，患者在接受治疗后，其神经超声异常均可能出现恶化。