目的 分析梅毒患者血清固定的影响因素,为预防梅毒患者血清固定提供依据.方法 选择2018年9月—2020年9月在浙江省皮肤病防治研究所诊疗的梅毒患者为调查对象,采用自行设计的问卷收集基本信息和治疗方案,通过浙江省皮肤病防治研究所电子病历系统收集初始非梅毒螺旋体抗体滴度资料.采用多因素Logistic回归模型分析梅毒患者血清固定的影响因素.结果 共纳入梅毒患者378例,年龄为(36.22±10.99)岁;男性192例,占50.79％.血清固定患者62例,血清固定率为16.40％.多因素Logistic回归分析结果显示,＞30～50岁(OR=2.742,95％CI:1.315～5.718)、女性(OR=3.390,95％CI:1.798～6.390)、潜伏期梅毒(OR=3.168,95％CI:1.045～9.609)和初始非梅毒螺旋体抗体滴度≤1:16(OR=1.963,95％CI:1.079～3.570)是梅毒患者血清固定的危险因素,采用苄星青霉素治疗是梅毒患者血清固定的保护因素(OR=0.370,95％CI:0.186～0.734).结论 年龄、性别、疾病分期、初始非梅毒螺旋体抗体滴度和治疗药物是梅毒患者血清固定的影响因素.

麻风患者存在不同程度的细胞免疫缺陷,但机制尚不明确.巨噬细胞是一群表型和功能异质性的免疫细胞,是机体免疫反应的重要细胞组成,在体内通过多种途径参与麻风的炎症反应.巨噬细胞的表型极化受到多种因素调控,在结核样型麻风中,巨噬细胞呈M1表型;在瘤型麻风中,巨噬细胞呈M2表型.本文对巨噬细胞在麻风免疫致病机制中的作用研究进行综述,为麻风防治提供依据.

目的:建立麻风生物样本库,为解决"消除麻风危害"的关键科学问题提供生物资源.方法:山东省建立项目实施小组,协同相关省市麻风防治工作人员核实完善所在区域麻风患者临床信息,采集患者血液、组织等样本,然后采用相关技术处理各类生物标本,完成入库的同时将临床信息录入生物样本库管理系统.结果:自2005年建库以来,共收集到来自全国19个省份、19个民族的81,532份不同类型样本,其中组织标本35,268份,血液标本33,320份,微生物标本(鼻黏膜拭子)12,944份;以上述样本为基础开展了麻风的系列研究并取得原创性成果.结论:建成了国际上最大的麻风生物资源库,以资源库为基础开展国内外合作并取得一系列原创成果,为完成我国"消除麻风危害中长期规划(2011-2020)",进而为实现世界卫生组织"创造一个没有麻风的世界"贡献中国智慧奠定了基础.

ImportanceDapsone hypersensitivity syndrome (DHS) is the most serious adverse reaction associated with dapsone administration and one of the major causes of death in patients with leprosy, whose standard treatment includes multidrug therapy (MDT) with dapsone, rifampicin, and clofazimine. Although the HLA-B*13:01 polymorphism has been identified as the genetic determinant of DHS in the Chinese population, no studies to date have been done to evaluate whether prospective HLA-B*13:01 screening could prevent DHS by identifying patients who should not receive dapsone. ObjectiveTo evaluate the clinical use of prospective HLA-B*13:01 screening for reduction of the incidence of DHS by excluding dapsone from the treatment for patients with HLA-B*13:01-positive leprosy. Design, Setting, and ParticipantsA prospective cohort study was conducted from February 15, 2015, to April 30, 2018, in 21 provinces throughout China. A total of 1539 patients with newly diagnosed leprosy were enrolled who had not received dapsone previously. After excluding patients who had a history of allergy to sulfones or glucose-6-phosphate dehydrogenase deficiency, 1512 individuals underwent HLA-B*13:01 genotyping. All of the patients were followed up weekly for the first 8 weeks after treatment to monitor for adverse events. ExposuresPatients who were HLA-B*13:01 carriers were instructed to eliminate dapsone from their treatment regimens, and noncarrier patients received standard MDT. Main Outcomes and MeasuresThe primary outcome was the incidence of DHS. The historical incidence rate of DHS (1.0%) was used as a control. ResultsAmong 1512 patients (1026 [67.9%] men, 486 [32.1%] women; mean [SD] age, 43.1 [16.2] years), 261 (17.3%) were identified as carriers of the HLA-B*13:01 allele. A total of 714 adverse events in 384 patients were observed during the follow-up period. Dapsone hypersensitivity syndrome did not develop in any of the 1251 patients who were HLA-B*13:01-negative who received dapsone, while approximately 13 patients would be expected to experience DHS, based on the historical incidence rate of 1.0% per year (P=2.05x10(-5)). No significant correlation was found between other adverse events, including dermatologic or other events, and HLA-B*13:01 status. Conclusions and RelevanceProspective HLA-B*13:01 screening and subsequent elimination of dapsone from MDT for patients with HLA-B*13:01-positive leprosy may significantly reduce the incidence of DHS in the Chinese population.

Objective: To assess the effect of the monitoring system of leprosy suspicious symptoms. Meth-ods: The time of delayed diagnosis, misdiagnosis rate in new cases and grade II disability incidence were as-sessed before and after the implementation of the system. Results: After implementation of the system,the time of delayed diagnosis was shortened from 36.64 to 17.86 months, the grade II disability incidence decreased from 23.15% to 12.12% and the misdiagnosis rate decreased from 23.15% to 12.12%. Conclusion: The im-plementation of the monitoring system of leprosy suspicious symptom can improve early diagnosis of leprosy and reduce the grade II disability.

目的:探讨梅毒螺旋体(treponema pallidum,TP)抗体在诊断新生儿梅毒中的应用.方法:分别用甲苯胺红不加热血清试验(TRUST)、TP-ELISA和密螺旋体颗粒凝集实验(TPPA)法对84例确诊新生儿梅毒患者与100例健康新生儿血清进行检测.结果:三种检测梅毒螺旋体抗体方法的灵敏度分别为51.2％、98.8％和100％,相对而言,TRUST法不适合作为诊断新生儿梅毒的初筛试验.结论:TP-ELISA法灵敏度与特异性相对较高,操作简便易行,建议作为诊断新生儿梅毒的初筛试验;TPPA法由于操作繁琐复杂,可结合临床作为新生儿梅毒的确诊试验.

我国麻风病疗养机构普遍面临着生存发展的压力,如何充分挖掘既往的优秀文化传统,加强麻风病院的文化建设,全面提升整体管理水平,实现麻风病院的成功转型升级,确保麻风病疗养机构的可持续发展,在当下具有特别重要的意义.本文针对我国麻风病疗养机构开展文化建设的意义、内容及有关注意事项进行了深入阐述,重点强调了麻风病院精神文化建设的重要性,目的是为我国麻风病疗养机构开展文化建设提供理论与实践的指导.

Objective:To determine the basic health status and the influencing factors for the ex-leprosy patients. Methods:A questionaire was used to collect the information on health status among the registered ex-leprosy patients in the province. Results: The prevalence of chronic disease was 59. 9% mainly including hypertension gastropathy bronchitis osteoarthrosis and diabetes mellitus. Gender age inhabitation and disability were the main influencing factors for the health status. Conclusion: The health status among the ex-leprosy patients is not optimistic. More care in terms of psychological intervention rehabilitation and social care should be strengthened.

Objective: To assess economic interest of the monitoring system of leprosy suspicious symp￣toms. Methods:The economic interest of the monitoring system was assessed by the cost-effectiveness, cost-utility and cost-benefit analysis. Results:The total investment of the system was ￥1.5723 million. The disa￣bled incidence was decreased 43.48%;the times of misdiagnosis were reduced 1.8;the time of delayed diag￣nosis was shortened 18.1 momths. The￥21.5818 million were saved from the medical costs, carfare, DALY, etc. Conclusion:The monitoring system of leprosy suspicious symptom can reduce disabled incidence and the economic burden for the patients, which has the significant economic value.

为了解浙江省基层医务人员麻风病防治基础知识知晓率,提高基层医务人员的麻风病诊治水平,在中国-荷兰麻风病防治合作卫生系统研究项目的支持下,浙江省皮肤病防治研究所于2011年11月对浙江省部分市和县级市的105名基层医务人员进行了调查,现报告如下.

Objective To understand the awareness of STD related knowledge among technicians of STDs laboratories and to provide scientific basis for developing strategies of STD prevention and treatment.Methods Forty eight technicians were selected from 21 STD laboratories in high-epidemic regions of Zhejiang province using random sampling and were surveyed with the same questionnaire.Results Of the surveyed technicians 13 were from province-level SDT laboratories,9 were from city-level laboratories and 26 were from county-level laboratories;they were aged from 22 to 55 years,with the mean age of 35.31 ± 7.67 years.As to their educational backgrounds,4 were graduates of laboratory technical schools,12 were college graduates,and 32 were university graduates,So far technical titles were concerned,21 were assistant technicians,24 were technicians in charge and 3 were deputy-chief technicians.The lowest scores of SDT related knowledge were 14 points,the highest were 29 points,and the average scores were 21.19 points.Conclusion Most of the technicians of STD laboratories in highly epidemic regions of our province have good command of STDs related testing knowledge,but the awareness of specific STDs professional knowledge was low.Capacity building of STD laboratories should be strengthened,in order to improve the accuracy and validaty of STDs testing.

长期以来,社会上存在着严重的麻风恐惧心理,这不仅严重危害了患者的身心健康和社会利益,也阻碍了麻风防治工作的顺利开展.为了解中学生对麻风知识的了解程度、态度、行为以及专题讲座等宣传教育方式的效果,我们于2010 年对893 名中学生进行了麻风健康教育,并对干预效果进行评价.

目的:总结浙江省2010年麻风误诊情况,为麻风防治提供依据及为相关医师提供临床参考.方法:收集2010年全省新发现麻风病例中误诊病例的临床资料,分析误诊原因.结果:医生警惕性下降、麻风临床表现复杂和诊断水平不高是主要原因.结论:在麻风低流行省份,提高医生的警惕性、强化麻风知识培训和麻风防治体制上创新是防止误诊的关键.

近10余年来,浙江省麻风病整体处于低流行状态,对于广大麻风受累者的相关防治服务,已经实现了由垂直性麻风防治系统直接提供向基层综合性卫生服务体系具体承担的转变,麻风病防治相关专业机构目前仅承担规划、督导、培训、技术支持、转诊服务等较宏观性任务.

Objective To investigate the knowledge,attitude,and practice about leprosy,and the requirement of health education on leprosy among floating population and to evaluate the effect of leprosy health education in floating population.Methods Totally 359 floating people were investigated before and after a health education program using the same questionnaire.Results For all the floating people,57.66% came from the high-epidemic areas of leprosy and 82.73% had heard leprosy or seen lepers before the health education.The rate of knowledge related to leprosy was improved after the health education and the rate of fear and discrimination against leprosy was reduced.The percentage of the persons being not afraid of lepers and like to contact with the cured lepers increased from 25.91% to 45.13% and 15.60% to 31.75% after the health education among the floating people.Conclusion The special program is an effective measure to carry out leprosy health education among floating population.

Objective To understand financial burden of leprosy hospital patients with plantar ulcer in Zhejiang province and provide a theoretical basis for preventing leprosy's plantar ulcer.Methods The three leprosy villages were selected as the survey respondents by using self-made questionnaire for economic burden of leprosy plantar ulcer by trained personnel on prevention and treatment of leprosy plantar ulcer patients.Results There were eighty three leprosy patients with plantar ulcers in the villages,including 70 of the patients with complicated plantar ulcer and 11 of the patients with simple foot ulcers.The direct economic burden by foot ulcers in the past year including: dressing fee is 400-7300 yuan,a total of 250 003.80 yuan,an average of 3 378.43 yuan;treatment fee is 100-3 800 yuan(including six cases of amputation ulcer patients),a total of them is 31 530.70 yuan,with average of 389.27 yuan;medicine fee is 90-3 000 per month,a total of 30 377.40 yuan,an average of 506.29 yuan;inspection fee is 4 072.50 yuan,an average of 50.28 yuan.Indirect economic burden: nutrition fee is 20 076 yuan,an average of 247.85 yuan;protective footwear expenditure is 50-150 yuan,a total of 5,605.7 yuan,an average of 69.21 yuan.Conclusion Foot ulcers are a common complication of leprosy with relatively heavy economic burden.The state should increase investment in this area of health resources to reduce the leprosy burden in hospital patients.

我国艾滋病流行与发展形势日趋严重,且经性接触传播的比例呈逐年上升趋势[1],当艾滋病的传播转变为性传播为主时,最先遭受感染的就是娱乐场所女性性工作者[2].由于该人群流动性大,安全性行为知识欠缺,是艾滋病流行潜在的高危人群,在该人群中进行综合性干预措施对预防和控制艾滋病进一步蔓延具有十分重要的意义[3].本文对某地部分娱乐场所女性性工作者进行健康教育、咨询和免费发放安全套等综合性干预工作,比较干预前后艾滋病知识接受能力和行为态度的改变情况,评价干预效果.

目的探讨盐酸氮卓斯汀治疗慢性特发性荨麻疹的疗效。方法 96例患者采用开放性、治疗前后自身对照的方法,予盐酸氮卓斯汀片2mg,2次/d,早晚服用,共4周,对患者分别在入选时及治疗后1,2,4周进行症状、体征评分及总体疗效评估。结果盐酸氮卓斯汀治疗第1,2,4周,患者的瘙痒情况、风团数目、风团直径大小及症状总分均显著下降,与治疗前相比,差异有统计学意义(P<0.001)。总体疗效评估结果显示,治疗后1,2,4周患者的总缓解率分别达到64.58%,80.21%,84.38%。结论盐酸氮卓斯汀治疗慢性特发性荨麻疹临床疗效肯定,耐受性好,安全性高。

梅毒是由梅毒螺旋体引起的一种慢性全身性疾病,可以引起全身组织和器官的损害和病变,导致功能障碍、组织破坏乃至死亡[1].

为探索在医院开展对农村居民的艾滋病健康教育的工作方法,对浙江省皮肤病防治研究所住院的农村病人,进行了一次艾滋病认知现状调查.现将结果报告如下.