Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance
Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance
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DOI：
10.1016/j.jaad.2005.01.006
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发表时间：
2005-06-01
影响因子：
13.8
通讯作者：
English, JC
中科院分区：
文献类型：
--
作者：
Spicknall, KE;Zirwas, MJ;English, JC
手指棍击可能是一个引人注目的物理发现。在其他情况下，仅凭主观检查很难确定是否存在棒状，需要通过侧位角度或远端指骨与指骨间深度比来证实。大多数棍棒状指的显微镜和影像学研究显示远端指血管增生。最近的研究表明，当血小板前体在肺循环中不能破碎成血小板时，它们很容易被困在外周脉管系统中，释放血小板源性生长因子和血管内皮生长因子，促进血管形成，最终导致棒化。临床上，棍棒与许多肿瘤、肺部、心脏、胃肠道、感染性、内分泌、精神和多系统疾病有关。为了缩小鉴别诊断范围，我们建议详细的病史和体格检查，并辅以重点实验室和影像学检查。提出了一种评价新诊断球杆的算法。
Finger clubbing can be a striking physical finding. At other times, the presence of clubbing is difficult to establish by Subjective examination alone Lind the profile angle or distal phalangeal to interphalangeal depth ratio are needed to confirm the finding. Most microscopic and imaging Studies of clubbed fingers reveal hypervascularization of the distal digits. Recent research shows that when platelet precursors fail to become fragmented into platelets within the pulmonary circulation, they are easily trapped in the peripheral vasculature, releasing platelet-derived growth factor and vascular endothelial growth factor, promoters of vascularity and, ultimately, clubbing. Clinically, clubbing is associated with a number of neoplastic, pulmonary, cardiac, gastrointestinal, infectious, endocrine, psychiatric, and multisystem diseases. In narrowing the differential diagnosis, we recommend a detailed history and physical examination accompanied by focused laboratory and imaging studies. An algorithm for the evaluation of newly diagnosed clubbing is suggested.