结节性红斑的临床特点及其对结核病的诊断价值  

Clinical features of erythema nodosum and its diagnostic value for tuberculosis

作　　者：杨松[1] 严晓峰[1] YANG Song;YAN Xiao-feng(Chongqing Public Health Medical Center,Chongqing 400036,China)

机构地区：[1]重庆市公共卫生医疗救治中心,400036

出　　处：《中国防痨杂志》2019年第11期1227-1230,共4页Chinese Journal of Antituberculosis

基　　金：重庆市技术创新与应用示范(社会民生类)项目(cstc2018jscx-msybX0062);重庆市科卫联合医学科研项目(2019ZDXM035)。

摘　　要：结节性红斑(erythema nodosum,EN)是皮肤科患者一种常见体征,可见于全身多系统疾病。本综述目的旨在了解EN的临床特点及其对活动性结核病(tuberculosis,TB)的诊断价值。临床上EN主要表现为突然发作的、主要位于小腿伸侧的红色、痛性皮下软结节和斑块,与感染、药物、结节病、妊娠、炎症性肠病、口服避孕药、自身免疫性疾病、抗生素、激素反应、寄生虫感染、淋巴瘤和其他恶性肿瘤等有关,约50%病因不明,EN是由各种刺激因子引起的迟发性超敏反应。临床上非典型病例的诊断主要依赖于活检或诊断性治疗。由于EN复杂的病因,需排除皮肤结核、麻风、结节病、结节性动脉炎等全身性疾病。在TB流行区,活动性TB和结核分枝杆菌感染与EN密切相关。活动性TB并发EN、结核分枝杆菌感染并发EN患者进行抗结核治疗有助于EN症状改善、预防EN复发和控制活动性TB病情。EN与包括TB或其他全身系统疾病相关,但EN的病因有待于深入研究,EN可能是TB的早期表现,联合结核菌素皮肤试验、抗酸染色检测及影像学等技术或诊断性抗结核治疗,有助于EN并发结核分枝杆菌感染或TB的早期确诊和治愈。Erythema nodosum(EN)is a common sign in department of dermatology and can be seen in systemic multiple system diseases.The purpose of this article is to explore the clinical features of erythema nodosum and to evaluate its diagnostic value for active tuberculosis(TB).Clinically,erythema nodosum presents with a sudden onset of red,painful,subcutaneous soft nodules and plaques,mainly localized to the extension of calf.EN may be associated with a variety of conditions such as infection,medications,sarcoidosis,pregnancy,inflammatory bowel disease,oral contraceptive,autoimmune disease,antibiotics,hormone response,lymphoma and other malignancy causes.The causes are unclear in around 50%of cases.It is well known that EN is a delayed hypersensitivity reaction induced by various stimulants.The clinical diagnosis for the atypical cases mainly depend on the biopsy or diagnostic treatment.Because of the complex etiology of EN,systemic diseases such as skin tuberculosis,leprosy,sarcoidosis and nodular arteritis need to be excluded.In the TB epidemic area,Mycobacterium tuberculosis infection(MTI)and active tuberculosis are closely related to EN.It is helpful to improve the EN symptoms,prevent EN relapse and control the active TB conditions through anti-tuberculous treatment in the patients who have active TB combined with EN and MTI with EN.EN can be associated with systemic multisystem diseases including tuberculosis,but further studies need to be done to reveal the underlying causes of EN.EN may be an early symptom of TB.It can be helpful for early diagnosis and treatment of the patients who have MTI with EN or TB with EN by the combination of tuberculin skin test(TST),acid-fast bacillus(AFB)detection and imaging techniques or diagnostic anti-tuberculosis treatment.

关 键 词：红斑 结节性 结核 疾病特征 超敏反应 迟发型 因果律 综述文献(主题) 

分 类 号：R52[医药卫生—内科学]