Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study) 英文参考文献.docVIP

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Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study) 英文参考文献.doc

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Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study) 英文参考文献

EarlyDiagnosisofNeuropathyinLeprosy—Comparing DiagnosticTestsinaLargeProspectiveStudy(theINFIR CohortStudy) WimH.vanBrakel1*,PeterG.Nicholls2,EinarP.Wilder-Smith3,LorettaDas4,PramilaBarkataki5, DianaN.J.Lockwood6,onbehalfoftheINFIRStudyGroup 1RoyalTropicalInstitute(KIT),Amsterdam,TheNetherlands,2SchoolofNursingandMidwifery,UniversityofSouthampton,Southampton,UnitedKingdom,3Divisionof Neurology,NationalUniversityHospital,Singapore,4NainiCommunityHospital,AllahabadDistrict,UttarPradesh,India,5TLMHospitalFaizabad,FaizabadDistrict,Uttar Pradesh,India,6LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom Abstract Background:Leprosyisthemostfrequenttreatableneuromusculardisease.Yet,everyyear,thousandsofpatientsdevelop permanentperipheralnervedamageasaresultofleprosy.Sinceearlydetectionandtreatmentofneuropathyinleprosyhas strongpreventivepotential,weconductedacohortstudytodeterminewhichtestdetectsthisneuropathyearliest. MethodsandFindings:Onehundredandeighty-eightmultibacillary(MB)leprosypatientswereselectedfromacohortof 303 and followed for 2 years after diagnosis. Nerve function was evaluated at each visit using nerve conduction (NC), quantitative thermal sensory testing and vibrometry, dynamometry, monofilament testing (MFT), and voluntary muscle testing(VMT).StudyoutcomesweresensoryandmotorimpairmentdetectedbyMFTorVMT.Seventy-fourof188patients (39%) had a reaction, neuritis, or new nerve function impairment (NFI) event during a 2-year follow-up. Sub-clinical neuropathy was extensive (20%–50%), even in patients who did not develop an outcome event. Sensory nerve action potential(SNAP)amplitudes,compoundmotoractionpotential(CMAP)velocities,andwarmdetectionthresholds(WDT) weremostfrequentlyaffected,withSNAPimpairmentfrequenciesrangingfrom30%(median)to69%(sural).Velocitywas impairedinupto43%ofmotornerves.WDTsweremorefrequentlyaffectedthancolddetectionthresholds(29%versus 13%,ulnarnerve).ImpairmentofSNCandwarmperceptionoftenprecededdeteriorationinMForVMTscoresby1