Erythema nodosum: etiologic and predictive factors in a defined population.
Erythema nodosum: etiologic and predictive factors in a defined population.
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DOI：
10.1002/1529-0131(200003)43:3
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发表时间：
2000-03
影响因子：
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通讯作者：
C. García‐Porrúa;M. González-Gay;M. Vázquez-Caruncho;L. López-Lázaro;M. Lueiro;M. Fernandez;J. Alvarez‐Ferreira;R. Pujol
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作者：
C. García‐Porrúa;M. González-Gay;M. Vázquez-Caruncho;L. López-Lázaro;M. Lueiro;M. Fernandez;J. Alvarez‐Ferreira;R. Pujol
目的研究结节性红斑（EN）的频率和特征，建立疾病相关性，并确定继发性EN发生的最佳预测因子。方法：我们对1988年至1997年间在转诊医院确诊的14岁及以上经活检证实的EN患者进行了回顾性研究。如果皮肤结节发生在明确定义的疾病背景下，或者如果在EN发作的时间附近有突发事件，则将患者分类为特发性EN或继发于其他疾病的EN。结果106例患者（82名女性）被诊断为活检证实的EN。在诊断时，36.8%的患者未发现突发事件或基础疾病。结节病和非链球菌性上呼吸道感染（URI）是继发性EN最常见的相关疾病。在35例首次诊断为特发性EN并随访至少1年的患者中，只有1例最终诊断为继发性EN。继发性EN的最佳预测模型包括胸片异常结果、既往非链球菌性URI病史以及间隔2-4周连续2次测定中抗链球菌溶血素O（阿索）滴度的显著变化。外周滑膜炎、结核菌素皮肤试验阳性和腹泻史提示继发性EN。该模型具有较高的敏感性和特异性。结论特发性EN常见。一个基本的程序，包括仔细的病史采集，周围滑膜炎的体格检查，连续2次阿索测定，结核菌素皮肤试验和胸部X线摄影可能足以诊断EN。
OBJECTIVE To examine the frequency and features of erythema nodosum (EN), establish disease associations, and identify the optimal set of predictors for the occurrence of secondary EN. METHODS We performed a retrospective study of an unselected population of patients 14 years and older with biopsy-proven EN diagnosed at a referral hospital between 1988 and 1997. Patients were classified as having either idiopathic EN or EN secondary to other diseases if the skin nodules occurred in the context of a well-defined disease, or if there was a precipitating event in close temporal proximity to the onset of EN. RESULTS One hundred six patients (82 women) were diagnosed as having biopsy-proven EN. At the time of diagnosis, no precipitating events or underlying diseases were identified in 36.8% of patients. Sarcoidosis and nonstreptococcal upper respiratory tract infections (URI) were the most common conditions associated with secondary EN. Only 1 of 35 patients with an initial diagnosis of idiopathic EN and a followup of at least 1 year was finally diagnosed as having secondary EN. The best predictive model of secondary EN included an abnormal results on a chest radiograph, a previous history of nonstreptococcal URI, and a significant change in antistreptolysin O (ASO) titer in 2 consecutive determinations performed in a 2-4-week interval. Also, the presence of peripheral synovitis, a positive tuberculin skin test, and a history of diarrhea suggested the presence of secondary EN. This model showed high sensitivity and specificity. CONCLUSION Idiopathic EN is common. A basic procedure including careful medical history-taking, a physical examination for peripheral synovitis, 2 consecutive ASO determinations, a tuberculin skin test, and chest radiography may be sufficient to diagnose EN.