LYMPHADENOPATHY
LYMPHADENOPATHY
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DOI：
10.1136/adc.73.5.476
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发表时间：
1995-11-01
影响因子：
5.2
通讯作者：
MORLAND, B
中科院分区：
文献类型：
--
作者：
MORLAND, B
淋巴结肿大是儿童常规体格检查的常见结果。全科医生面临的困境是何时向儿科医生咨询;儿科医生的困境是决定如何广泛地调查儿童。虽然大多数病例将有一个良性的，迅速解决的过程，淋巴结病和潜在的威胁生命的疾病，如癌症的公认协会引起担心和焦虑的家庭和医生照顾孩子。这种担忧本身可能会引发不适当的快速或过度积极的尝试来确定诊断。一个有组织的方法对儿童淋巴结病将有助于临床医生作出适当的决定，关于治疗和进一步的调查。历史详细的历史应集中在诊断线索，并以功能提示更险恶的病理。淋巴结病的持续时间可能是有帮助的，大多数感染性疾病的病史都很短（少于两周）。长期存在的淋巴结病可能由多种疾病引起，包括感染（HIV，EB病毒，结核病等），恶性肿瘤，炎症和自身免疫性疾病，但虽然长期存在（超过一年）淋巴结肿大可能是病理性的，但不太可能是由于恶性肿瘤。应注意相关的皮疹（皮疹），旅行和接触宠物（特别是猫）。应寻找相关的全身症状：体重减轻（6个月以上> 10%）、发热和盗汗、尿道炎和肌痛/关节痛。虽然这些症状的存在很重要，但它们并不像人们经常认为的那样是淋巴瘤的特异性。只有三分之一的儿童霍奇金病和10%的非霍奇金淋巴瘤显示体质症状。
Lymph node enlargement is a common finding on routine physical examination of children. The dilemma facing general practitioners is when to refer to paediatricians; the dilemma for paediatricians is deciding how extensively to investigate children. While the majority of cases will have a benign, rapidly resolving course, the well recognised associations of lymphadenopathy and potentially life threatening diseases such as cancer cause worry and anxiety to both families and doctors caring for children. This concern may in itself initiate an inappropriately rapid or over aggressive attempt at determining the diagnosis. An organised approach to children with lymphadenopathy will help the clinician make appropriate decisions regarding treatment and further investigation.History A detailedhistory should focus both on diagnostic clues, and to features suggestive of more sinister pathology. Duration of lymphadenopathy may be helpful, most infectious causes producing a short (less than two week) history. Long standing lymphadenopathy may be caused by a variety of diseases including infections (HIV, Epstein-Barr virus, tuberculosis, etc), malignancy, inflammation, and auto-immune disease, but while very long standing (over one year) lymph node enlargement is likely to be pathological, it is unlikely to be due to malignancy. Attention should be made to associated rashes (exanthemata), travel, and exposure to pets (particularly cats). Associated constitutional symptoms should be sought: weight loss (> 10% over six months), fever and night sweats, pruritis, and myalgia/arthralgia. While the presence of such symptoms is important, they are not specific, as frequently believed, for lymphoma. Only one third of children with Hodgkin's disease and 10% with non-Hodgkin's lymphoma display con-stitutional symptoms.