Kamiya Naoko, Ishikawa Yukiko, Takeshima Taro, Sagara Yuka, Yamamoto Sayaka, Naka Mieno Makiko, Kotani Kazuhiko, Matsumura Masami
Division of General Internal Medicine Jichi Medical University Hospital Shimotsuke-shi Japan.
Department of General Medicine Shirakawa Satellite for Teaching and Research Fukushima Medical University Shirakawa-shi Japan.
J Gen Fam Med. 2020 Oct 18;22(2):75-80. doi: 10.1002/jgf2.386. eCollection 2021 Mar.
Cervical lymphadenopathy is commonly seen in general practice, and its etiology is diverse. Establishing the diagnostic strategy for lymphadenopathy would be desirable to avoid overlooking neoplasms or other critical conditions. This study aims to identify the useful laboratory parameters for cervical lymphadenopathy that require clinical observation or intervention.
The participants were outpatients presenting cervical swelling or cervical lymph node (LN) pain who consulted the General Internal Medicine department from 2010 to 2016. We evaluated the characteristics, physical findings, and laboratory parameters with final diagnoses by multivariate logistic regression analysis. We categorized the final diagnoses as "Clinical Intervention Required Group (CIRG)" including necrotizing lymphadenitis, hematologic neoplasms, metastatic lymphadenopathy, tuberculous lymphadenitis, bacterial infectious diseases, infectious mononucleosis, autoimmune diseases, and other abnormal conditions or "No-CIRG" not requiring further clinical observation or intervention.
We evaluated 409 participants, with 130 (31.8%) diagnosed as belonging to the CIRG. There was an association between CIRG and various parameters: age ≥60 years old (adjusted odds ratio [AOR], 2.70; 95% confidence interval [CI], 1.48-4.90), having a referral (AOR, 1.83; 95% CI, 1.12-3.00), diameter of LN ≥ 2 cm (AOR, 1.91; 95% CI, 1.05-3.48), fixed LNs (AOR, 2.74; 95% CI, 1.02-7.37), and lactate dehydrogenase (LD) ≥400 U/L (AOR, 3.78; 95% CI, 1.46-9.77). Eighty-two percent of LD ≥ 400 cases in the CIRG were infectious mononucleosis or necrotizing lymphadenitis.
Besides the clinical indicators reported previously, we may apply an elevated LD level as a useful indicator of cervical lymphadenopathy that requires further clinical observation or intervention.
颈部淋巴结病在普通医疗实践中较为常见，其病因多样。制定淋巴结病的诊断策略有助于避免漏诊肿瘤或其他严重疾病。本研究旨在确定需要临床观察或干预的颈部淋巴结病的有用实验室参数。
研究对象为2010年至2016年到普通内科就诊的出现颈部肿胀或颈部淋巴结疼痛的门诊患者。通过多因素逻辑回归分析评估其特征、体格检查结果及实验室参数，并得出最终诊断。我们将最终诊断分为“需要临床干预组（CIRG）”，包括坏死性淋巴结炎、血液系统肿瘤、转移性淋巴结病、结核性淋巴结炎、细菌性传染病、传染性单核细胞增多症、自身免疫性疾病及其他异常情况，以及“非CIRG组”，即不需要进一步临床观察或干预的情况。
我们评估了409名参与者，其中130名（31.8%）被诊断属于CIRG组。CIRG组与多种参数之间存在关联：年龄≥60岁（校正比值比[AOR]，2.70；95%置信区间[CI]，1.48 - 4.90）、有转诊（AOR，1.83；95% CI，1.12 - 3.00）、淋巴结直径≥2 cm（AOR，1.91；95% CI，1.05 - 3.48）、淋巴结固定（AOR，2.74；95% CI，1.02 - 7.37）以及乳酸脱氢酶（LD）≥400 U/L（AOR，3.78；95% CI，1.46 - 9.77）。CIRG组中LD≥400的病例有82%为传染性单核细胞增多症或坏死性淋巴结炎。
除了先前报道的临床指标外，我们可以将升高的LD水平作为需要进一步临床观察或干预的颈部淋巴结病的有用指标。
