การรักษาและการจัดการผู้ป่วยโรคเรื้อนที่มีภาวะเห่อชนิดที่ 1
คำสำคัญ:
โรคเรื้อน, โรคเห่อชนิดที่ 1, การรักษาบทคัดย่อ
การวิจัยเอกสารโดยการทบทวนงานวิจัยชนิด Randomized Controlled Trials (RCT) ของการรักษา และการจัดการผู้ป่วยโรคเรื้อนที่มีภาวะเห่อชนิดที่ 1 (Type 1 Reactions) ที่ทบทวนค้นคว้าใน Cochrane Clinical trials, PubMed และงานวิจัยของประเทศไทย ข้อมูลค้นคว้าถึง กุมภาพันธ์ 2552 จากการศึกษาพบว่ามี 4 RCT ที่การรักษาผู้ป่วยโรคเรื้อนที่มีภาวะเห่อชนิดที่ 1 (Type 1 Reactions) ด้วยการให้กินยา corticosteroids แต่ยังขาดข้อมูลที่มากพอที่จะยอมรับขนาด และระยะเวลาที่ให้ยา มีงานวิจัยหนึ่งให้ผลว่าการรักษาด้วย prednisolone regimen (total dose 2.31 กรัม) นาน 5 เดือน ลดการเพิ่ม prednisolone ในผู้ป่วย ได้ผลการรักษาดีกว่า prednisolone regimen (total dose 2.94 กรัม) นาน 3 เดือน ในการรักษา Nerve function impairment (NFI) ด้วยยา steroid ได้ผลตั้งแต่ร้อยละ 33 - 73 แต่ข้อมูลมีขนาดน้อยจึงไม่สามารถสรุปขนาดยา steroid ที่เหมาะสมในการรักษาได้ จึงจำเป็นต้องมีการทำการศึกษาทดลองเพิ่มเติม
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เอกสารอ้างอิง
1. Ranque B, Nguyen VT, Vu HT et al. Age is an important risk factor for onset and sequelae of reversal reactions in Vietnamese patients with leprosy. Clin Infect Dis, 2007; 44: 33-40.
2. Saunderson P, Geber S, Desta K et al. The pattern of leprosy-related neuropathy in the AMFES patients in Ethiopia: definitions, incidence, risk factors and outcome. Lepr Rev, 2000; 71: 285- 308.
3. Croft RP, Nicholls PG, Richardus JH, Smith WC. The treatment of acute nerve function impairment in leprosy: results from a prospective cohort study in Bangladesh. Lepr Rev, 2000; 71: 154-168.
4. Ridley DS, Jopling WH. Classification of leprosy according to immunity. Int J Lepr Other Mycobact Dis, 1966; 34: 255-273.
5. Modlin RL, Melancon-Kaplan J, Young SM et al. Learning from Lesions: patterns of tissue inflammation in leprosy. Proc Natl Acad Sci USA, 1988; 85:n1213-1217.
6. Kumar B, Dogra S, Kaur I. Epidemiological characteristics of leprosy reactions: 15 years experience from north India. Int J Lepr Other Mycobact Dis, 2004; 72: 125-133.
7. Lockwood DN, Lucas SB, Desikan K, et al. The histological diagnosis of leprosy Type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol, 2008 March 6.
8. van Brakel WH, Nicholls PG, Das L et al. The INFIR cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Lepr Rev, 2005; 76: 14-34.
9. van Brakel WH, Nicholls PG, Wilder-Smith EP et al Early Diagnosis of Neuropathy in Leprosy- Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study). PLoS Negl Trop Dis, 2008; 2: e212.
10. Schreuder PA. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand. 1987-1995 [correction of 1978-1995]. II. Reactions Int J Lepr Other Mycobact Dis 1998, 1998; 66: 159-169.
11. Van Brakel WH, Khawas IB, Lucas SB. Reactions in leprosy: an epidemiological study of 386 patients in west Nepal. Lepr Rev, 1994; 65: 190-203.
12. Lockwood DN, Sinha HH. Pregnancy and leprosy: a comprehensive literature review. Int J Lepr Other Mycobact Dis, 1999; 67: 6-12.
13. Saunderson P, Gebre S, Byass P. Reversal reactions in the skin lesions of AMFES patients: incidence and risk factors. Lepr Rev, 2000; 71: 309-317.
14. Sarno EN, Illarramendi X, Nery JA et al. HIVM. leprae interaction: can HAART modify the course of leprosy? Public Health Rep, 2008; 123: 206-212.
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16. Job CK. Pathology of leprosy. In: Hastings RC (ed). Leprosy, 2nd edn. Churchill Livingstone, Edinburgh, 1994; pp. 193-234.
17. Lockwood DN, Colston MJ, Khanolkar-Young SR. The detection of Mycobacterium leprae protein and carbohydrate antigens in skin and nerve from leprosy patients with type 1 (reversal) reactions. Am J Trop Med Hyg, 2002; 66: 409-415.
18. Sousa AL, Stefani MM, Pereira GA et al. Mycobacterium leprae DNA Associated with Type 1 Reactions in Single Lesion Paucibacillary Leprosy Treated with Single Dose Rifampin, Ofloxacin, and Minocycline. Am J Trop Med Hyg, 2007; 77: 829-833.
19. Oliveira RB, Ochoa MT, Sieling PA et al. Expression of Toll-like receptor 2 on human Schwann cells: a mechanism of nerve damage in leprosy. Infect Immun, 2003; 71: 1427-1433.
20. Ochoa MT, Stenger S, Sieling PA et al. T-cell release of granulysin contributes to host defense in leprosy. Nat Med, 2001; 7: 174-179.
21. Bochud PY, Hawn TR, Siddiqui MR et al. Tolllike receptor 2 (TLR2) polymorphisms are associated with reversal reaction in leprosy. J Infect Dis, 2008; 197: 253-261.
22. Misch EA, Macdonald M, Ranjit C et al. Human TLR1 Deficiency Is Associated with Impaired Mycobacterial Signaling and Protection from Leprosy Reversal Reaction. PLoS Negl Trop Dis, 2008; 2: e231.
23. Johnson CM, Lyle EA, Omueti KO et al. Cutting edge: a common polymorphism impairs cell surface trafficking and functional responses of TLR1 but protects against leprosy. J Immunol, 2007; 178: 7520-7524.
24. Khanolkar-Young S, Rayment N, Brickell PM et al. Tumour necrosis factor-alpha (TNF-alpha) synthesis is associated with the skin and peripheral nerve pathology of leprosy reversal reactions. Clin Exp Immunol, 1995; 99: 196-
202.
25. Little D, Khanolkar-Young S, Coulthart A et al. Immunohistochemical analysis of cellular infiltrate and gamma interferon, interleukin-12, and inducible nitric oxide synthase expression in leprosy type 1 (reversal) reactions before and during prednisolone treatment. Infect Immun, 22001; 69: 3413-3417.
26. Kirkaldy AA, Musonda AC, Khanolkhar-Young S et al. Expression of CC and CXC chemokines and chemokine receptors in human leprosy skin lesions. Clin Exp Immunol, 2003; 134: 447-453.
27. Andersson AK, Chaduvula M, Atkinson SE et al. Effects of prednisolone treatment on cytokine expression in patients with leprosy type 1 reactions. Infect Immun, 2005; 73: 3725-3733.
28. Simmons CP, Thwaites GE, Quyen NT et al. The clinical benefit of adjunctive dexamethasone in tuberculous meningitis is not associated with measurable attenuation of peripheral or local immune responses. J Immunol, 2005; 175: 579-590.
29. Andersson AK, Atkinson SE, Khanolkar-Young S et al. Alteration of the cortisol- cortisone shuttle in leprosy type 1 reactions in leprosy patients is Hyderabad, India. Immunol Lett. 2007; 109: 72-75.
30. Lockwood DN, Vinayakumar S, Stanley JN et al. Clinical features and outcome of reversal (type 1 ) reactions in Hyderabad, India. In K Lepr Other Mycobact Dis, 1993; 61: 8-15.
31. Santaram V, Porichha D. Reaction cases treated at the Regional Leprosy Training and Research Institute, Aska, Orissa: a retrospective analysis. Indian J Lepr, 2004; 76: 310-320.
32. Hogeweg M, Kiran KU, Suneetha S. The significance of facial patches and type I reaction for the development of facial nerve damage in leprosy. A retrospective study among 1226 paucibacillary leprosy patients. Lepr Rev, 1991;
62: 143-149.
33. Ponnighaus JM, Boerrigter G. Are 18 doses of WHO/MDT sufficient for multibacillary leprosy; results of a trial in Malawi. Int J Lepr Other Mycobact Dis, 1995; 63: 1-7.
34. Scollard DM, Smith T, Bhoopat L et al. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis, 1994; 62: 559-567.
35. Richardus JH, Finlay KM, Croft RP, Smith WC. Nerve function impairment in leprosy at diagnosis and at completion of MDT: a retrospective cohort study of 786 patients in Bangladesh. Lepr Rev, 1996; 67: 297-305.
36. Richardus JH, Nicholls PG, Croft RP et al. Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up. Int J Epidemiol, 2004; 33: 337-343.
37. Croft RP, Nicholls PG, Richardus JH, Smith WC. Incidence rates of acute nerve function impairment in leprosy: a prospective cohort analysis after 24 months (The Bangladesh Acute Nerve Damage Study). Lepr Rev, 2000; 71: 18-33.
38. Van Veen NH, Nicholls PG, Smith WC, Richardus JH. Corticosteroids for treating nerve damage in leprosy. Cochrane Database Syst Rev, 2007; CD005491.
39. Van Brakel WH, Nicholls PG, Lockwood DN et al. A scale to assess the severity of leprosy reactions. Lepr Rev, 2007; 78: 161-164.
40. Schreuder PA. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1987-1995 [correction of 1978-1995]. III. Neural and other impairments. Int J Lepr Other Mycobact Dis, 1998; 66: 170-181.
41. Bolen S, Tilburt J, Baffi C et al. Defining 'success' in recruitment of underrepresented population to cancer clinical trials: moving toward a more consistent approach. Cancer, 2006; 106: 1197-1204.
42. Le Grand A. Women and leprosy: a review. Lepr Rev, 1997; 68: 203-211.
43. Roche M, Convit J, Medina JA, Blomenfeld E. The effects of adrenocorticotropic hormone (ACTH) in lepromatous lepra reaction. Int J Lepr, 1951; 19: 137-145.
44. Perretti M, D' Acquisto F. Novel aspects of annexin 1 and glucocorticoid biology: intersection with nitric oxide and the lipoxin receptor. Inflamm Allergy Drug Targets, 2006; 5: 107-114.
45. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol, 2006; 148: 245-254.
46. Rao PS, Sugamaran DS, Richard J, Smith WC. Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy. Lepr Rev, 2006; 77: 25-33.
47. Smith WC, Anderson AM, Withington SG et al. Steroid prophylaxis for prevention of nerve function impairment in leprosy: randomized placebo controlled trial (TRIPOD 1). BMJ, 2004; 328(7454): 1459.y
48. http://www.who.int/lep/resources/SEAGLP20062.pdf was accessed on 30.11.2008
49. van Brakel WH, Khawas IB. Nerve function impairment in leprosy: an epidemiological and clinical study-Part 2: results of steroid treatment. Lepr Rev, 1996; 67: 104-118.
50. Richardus JH, Withington SG, Anderson AM et al. Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomized controlled trial (TRIPOD 3). Lepr Rev, 2003; 74: 311-318.
51. Pannikar VK, Ramprasad S, Reddy NR et al. Effect of epicondylectomy in early ulnar neuritis treated with steroids. Int J Lepr Other Mycobact Dis, 1984; 52: 501-505.
52. Boucher P, Millan J, Parent M, Moulia-Pela JP. Randomized controlled trial of medical and medico-surgical treatment of Hansen's neuritis. Acta Leprol, 1999; 11: 171-177.
53. Marlowe SN, Hawksworth RA, Butlin CR et al. Clinical outcomes in a randomized controlled study comparing azathioprine and prednisolone versus prednisolone alone in the treatment of severe leprosy type 1 reactions in Nepal. Trans R Soc Trop Med Hyg, 20004; 98: 602-609.
54. Marlowe SN, Leekassa R, Bizuneh E et al. Response to ciclosporin treatment in Ethiopian and Nepali patients with severe leprosy Type 1 reactions. Trans R Soc Trop Med Hyg, 2007; 101: 1004-1012.
55. Bwire R, Kawuma HJ. Type 1 reactions in leprosy, neuritis and steroid therapy: the impact of the human immunodeficiency virus. Trans R Soc Trip Med Hyg, 1994; 88: 315-316.
56. Lawn SD, Wood C, Lockwood DN. Borderline tuberculoid leprosy: an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Clin Infect Dis, 2003; 36: e5-e6.
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2. Saunderson P, Geber S, Desta K et al. The pattern of leprosy-related neuropathy in the AMFES patients in Ethiopia: definitions, incidence, risk factors and outcome. Lepr Rev, 2000; 71: 285- 308.
3. Croft RP, Nicholls PG, Richardus JH, Smith WC. The treatment of acute nerve function impairment in leprosy: results from a prospective cohort study in Bangladesh. Lepr Rev, 2000; 71: 154-168.
4. Ridley DS, Jopling WH. Classification of leprosy according to immunity. Int J Lepr Other Mycobact Dis, 1966; 34: 255-273.
5. Modlin RL, Melancon-Kaplan J, Young SM et al. Learning from Lesions: patterns of tissue inflammation in leprosy. Proc Natl Acad Sci USA, 1988; 85:n1213-1217.
6. Kumar B, Dogra S, Kaur I. Epidemiological characteristics of leprosy reactions: 15 years experience from north India. Int J Lepr Other Mycobact Dis, 2004; 72: 125-133.
7. Lockwood DN, Lucas SB, Desikan K, et al. The histological diagnosis of leprosy Type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol, 2008 March 6.
8. van Brakel WH, Nicholls PG, Das L et al. The INFIR cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Lepr Rev, 2005; 76: 14-34.
9. van Brakel WH, Nicholls PG, Wilder-Smith EP et al Early Diagnosis of Neuropathy in Leprosy- Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study). PLoS Negl Trop Dis, 2008; 2: e212.
10. Schreuder PA. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand. 1987-1995 [correction of 1978-1995]. II. Reactions Int J Lepr Other Mycobact Dis 1998, 1998; 66: 159-169.
11. Van Brakel WH, Khawas IB, Lucas SB. Reactions in leprosy: an epidemiological study of 386 patients in west Nepal. Lepr Rev, 1994; 65: 190-203.
12. Lockwood DN, Sinha HH. Pregnancy and leprosy: a comprehensive literature review. Int J Lepr Other Mycobact Dis, 1999; 67: 6-12.
13. Saunderson P, Gebre S, Byass P. Reversal reactions in the skin lesions of AMFES patients: incidence and risk factors. Lepr Rev, 2000; 71: 309-317.
14. Sarno EN, Illarramendi X, Nery JA et al. HIVM. leprae interaction: can HAART modify the course of leprosy? Public Health Rep, 2008; 123: 206-212.
15. Deps PD, Lockwood DN. Leprosy occurring as immune reconstitution syndrome. Trans R Soc Trop Med Hyg, 2008; 102: 966-968.
16. Job CK. Pathology of leprosy. In: Hastings RC (ed). Leprosy, 2nd edn. Churchill Livingstone, Edinburgh, 1994; pp. 193-234.
17. Lockwood DN, Colston MJ, Khanolkar-Young SR. The detection of Mycobacterium leprae protein and carbohydrate antigens in skin and nerve from leprosy patients with type 1 (reversal) reactions. Am J Trop Med Hyg, 2002; 66: 409-415.
18. Sousa AL, Stefani MM, Pereira GA et al. Mycobacterium leprae DNA Associated with Type 1 Reactions in Single Lesion Paucibacillary Leprosy Treated with Single Dose Rifampin, Ofloxacin, and Minocycline. Am J Trop Med Hyg, 2007; 77: 829-833.
19. Oliveira RB, Ochoa MT, Sieling PA et al. Expression of Toll-like receptor 2 on human Schwann cells: a mechanism of nerve damage in leprosy. Infect Immun, 2003; 71: 1427-1433.
20. Ochoa MT, Stenger S, Sieling PA et al. T-cell release of granulysin contributes to host defense in leprosy. Nat Med, 2001; 7: 174-179.
21. Bochud PY, Hawn TR, Siddiqui MR et al. Tolllike receptor 2 (TLR2) polymorphisms are associated with reversal reaction in leprosy. J Infect Dis, 2008; 197: 253-261.
22. Misch EA, Macdonald M, Ranjit C et al. Human TLR1 Deficiency Is Associated with Impaired Mycobacterial Signaling and Protection from Leprosy Reversal Reaction. PLoS Negl Trop Dis, 2008; 2: e231.
23. Johnson CM, Lyle EA, Omueti KO et al. Cutting edge: a common polymorphism impairs cell surface trafficking and functional responses of TLR1 but protects against leprosy. J Immunol, 2007; 178: 7520-7524.
24. Khanolkar-Young S, Rayment N, Brickell PM et al. Tumour necrosis factor-alpha (TNF-alpha) synthesis is associated with the skin and peripheral nerve pathology of leprosy reversal reactions. Clin Exp Immunol, 1995; 99: 196-
202.
25. Little D, Khanolkar-Young S, Coulthart A et al. Immunohistochemical analysis of cellular infiltrate and gamma interferon, interleukin-12, and inducible nitric oxide synthase expression in leprosy type 1 (reversal) reactions before and during prednisolone treatment. Infect Immun, 22001; 69: 3413-3417.
26. Kirkaldy AA, Musonda AC, Khanolkhar-Young S et al. Expression of CC and CXC chemokines and chemokine receptors in human leprosy skin lesions. Clin Exp Immunol, 2003; 134: 447-453.
27. Andersson AK, Chaduvula M, Atkinson SE et al. Effects of prednisolone treatment on cytokine expression in patients with leprosy type 1 reactions. Infect Immun, 2005; 73: 3725-3733.
28. Simmons CP, Thwaites GE, Quyen NT et al. The clinical benefit of adjunctive dexamethasone in tuberculous meningitis is not associated with measurable attenuation of peripheral or local immune responses. J Immunol, 2005; 175: 579-590.
29. Andersson AK, Atkinson SE, Khanolkar-Young S et al. Alteration of the cortisol- cortisone shuttle in leprosy type 1 reactions in leprosy patients is Hyderabad, India. Immunol Lett. 2007; 109: 72-75.
30. Lockwood DN, Vinayakumar S, Stanley JN et al. Clinical features and outcome of reversal (type 1 ) reactions in Hyderabad, India. In K Lepr Other Mycobact Dis, 1993; 61: 8-15.
31. Santaram V, Porichha D. Reaction cases treated at the Regional Leprosy Training and Research Institute, Aska, Orissa: a retrospective analysis. Indian J Lepr, 2004; 76: 310-320.
32. Hogeweg M, Kiran KU, Suneetha S. The significance of facial patches and type I reaction for the development of facial nerve damage in leprosy. A retrospective study among 1226 paucibacillary leprosy patients. Lepr Rev, 1991;
62: 143-149.
33. Ponnighaus JM, Boerrigter G. Are 18 doses of WHO/MDT sufficient for multibacillary leprosy; results of a trial in Malawi. Int J Lepr Other Mycobact Dis, 1995; 63: 1-7.
34. Scollard DM, Smith T, Bhoopat L et al. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis, 1994; 62: 559-567.
35. Richardus JH, Finlay KM, Croft RP, Smith WC. Nerve function impairment in leprosy at diagnosis and at completion of MDT: a retrospective cohort study of 786 patients in Bangladesh. Lepr Rev, 1996; 67: 297-305.
36. Richardus JH, Nicholls PG, Croft RP et al. Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up. Int J Epidemiol, 2004; 33: 337-343.
37. Croft RP, Nicholls PG, Richardus JH, Smith WC. Incidence rates of acute nerve function impairment in leprosy: a prospective cohort analysis after 24 months (The Bangladesh Acute Nerve Damage Study). Lepr Rev, 2000; 71: 18-33.
38. Van Veen NH, Nicholls PG, Smith WC, Richardus JH. Corticosteroids for treating nerve damage in leprosy. Cochrane Database Syst Rev, 2007; CD005491.
39. Van Brakel WH, Nicholls PG, Lockwood DN et al. A scale to assess the severity of leprosy reactions. Lepr Rev, 2007; 78: 161-164.
40. Schreuder PA. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1987-1995 [correction of 1978-1995]. III. Neural and other impairments. Int J Lepr Other Mycobact Dis, 1998; 66: 170-181.
41. Bolen S, Tilburt J, Baffi C et al. Defining 'success' in recruitment of underrepresented population to cancer clinical trials: moving toward a more consistent approach. Cancer, 2006; 106: 1197-1204.
42. Le Grand A. Women and leprosy: a review. Lepr Rev, 1997; 68: 203-211.
43. Roche M, Convit J, Medina JA, Blomenfeld E. The effects of adrenocorticotropic hormone (ACTH) in lepromatous lepra reaction. Int J Lepr, 1951; 19: 137-145.
44. Perretti M, D' Acquisto F. Novel aspects of annexin 1 and glucocorticoid biology: intersection with nitric oxide and the lipoxin receptor. Inflamm Allergy Drug Targets, 2006; 5: 107-114.
45. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol, 2006; 148: 245-254.
46. Rao PS, Sugamaran DS, Richard J, Smith WC. Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy. Lepr Rev, 2006; 77: 25-33.
47. Smith WC, Anderson AM, Withington SG et al. Steroid prophylaxis for prevention of nerve function impairment in leprosy: randomized placebo controlled trial (TRIPOD 1). BMJ, 2004; 328(7454): 1459.y
48. http://www.who.int/lep/resources/SEAGLP20062.pdf was accessed on 30.11.2008
49. van Brakel WH, Khawas IB. Nerve function impairment in leprosy: an epidemiological and clinical study-Part 2: results of steroid treatment. Lepr Rev, 1996; 67: 104-118.
50. Richardus JH, Withington SG, Anderson AM et al. Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomized controlled trial (TRIPOD 3). Lepr Rev, 2003; 74: 311-318.
51. Pannikar VK, Ramprasad S, Reddy NR et al. Effect of epicondylectomy in early ulnar neuritis treated with steroids. Int J Lepr Other Mycobact Dis, 1984; 52: 501-505.
52. Boucher P, Millan J, Parent M, Moulia-Pela JP. Randomized controlled trial of medical and medico-surgical treatment of Hansen's neuritis. Acta Leprol, 1999; 11: 171-177.
53. Marlowe SN, Hawksworth RA, Butlin CR et al. Clinical outcomes in a randomized controlled study comparing azathioprine and prednisolone versus prednisolone alone in the treatment of severe leprosy type 1 reactions in Nepal. Trans R Soc Trop Med Hyg, 20004; 98: 602-609.
54. Marlowe SN, Leekassa R, Bizuneh E et al. Response to ciclosporin treatment in Ethiopian and Nepali patients with severe leprosy Type 1 reactions. Trans R Soc Trop Med Hyg, 2007; 101: 1004-1012.
55. Bwire R, Kawuma HJ. Type 1 reactions in leprosy, neuritis and steroid therapy: the impact of the human immunodeficiency virus. Trans R Soc Trip Med Hyg, 1994; 88: 315-316.
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31-03-2011
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1.
อรรถเศรษฐ ว. การรักษาและการจัดการผู้ป่วยโรคเรื้อนที่มีภาวะเห่อชนิดที่ 1. Dis Control J [อินเทอร์เน็ต]. 31 มีนาคม 2011 [อ้างถึง 28 ธันวาคม 2025];37(1):60-74. available at: https://he01.tci-thaijo.org/index.php/DCJ/article/view/155647
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บทความที่ลงพิมพ์ในวารสารควบคุมโรค ถือว่าเป็นผลงานทางวิชาการหรือการวิจัย และวิเคราะห์ตลอดจนเป็นความเห็นส่วนตัวของผู้เขียน ไม่ใช่ความเห็นของกรมควบคุมโรค ประเทศไทย หรือกองบรรณาธิการแต่ประการใด ผู้เขียนจำต้องรับผิดชอบต่อบทความของตน
