弗兰克症候群:皮肤性病学、心脏病理学和神经学之间的联系。

Denis Čerimagić
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引用次数: 0

摘要

亲爱的编辑:虽然我的一些同事可能会对此感到惊讶,但作为一名神经学家,我注意到皮肤病学和神经病学之间有许多联系。神经学和皮肤学的体征和症状在许多临床实体中都很常见,特别是在所谓的吞噬病或神经皮肤综合征(Von Recklinghausen's disease 1型和2型,Bourneville-Pringle综合征,Sturge-Weber综合征,Von Hippel-Lindau综合征,Louis-Bar综合征)中(1)。术语“神经性皮炎”和“神经皮肤病”也证实了上述情况。检查是每一个临床检查的基础,是皮肤病学和神经科学的一个组成部分。因此,我想提醒你们的读者注意弗兰克的标志,这是皮肤病学和神经病学之间的另一个联系。弗兰克征为斜耳垂折痕(DELC),从耳屏向后沿小叶呈45度角延伸至耳廓边缘(图1)。它被描述为动脉粥样硬化的皮肤病学标志。弗兰克标志是以桑德斯·t·弗兰克医生的名字命名的,他在20名冠状动脉疾病患者中观察到这种皱褶,并于1973年在《新英格兰医学杂志》上发表了他的发现(2)。尽管这个标志已经被发现了50多年,但在临床实践中仍然没有常规使用。DELC阳性耳垂的组织病理学检查显示,耳垂底部动脉血管出现肌弹性纤维化,这表明DELC并非偶然发现,而是与动脉粥样硬化直接相关(3)。在冠状动脉疾病患者中发现DELC后,大量研究证实了周围血管疾病和脑血管疾病中都存在DELC。1991年,作为一名学生,我在内科学教科书上看到了对这一症状的描述(4)。克罗地亚作家也对这一症状进行了研究。1998年,miriki等人发现,阳性的Frank’s体征会增加心脏病发作的风险(5,6)。2008年,glaviki等人发现,作为动脉粥样硬化替代标志物的颈总动脉内膜中膜厚度(IMT)增加与Frank’s征像之间存在统计学意义上的相关性,从而证实了Frank’s征像是脑血管疾病不可控制的危险因素(如性别或年龄)的假设(7)。在临床实践中,耳垂检查应被视为体检的一个组成部分。在弗兰克氏征呈阳性的情况下,建议对颈部动脉进行彩色多普勒超声检查和心脏病专家检查。弗兰克体征的测定可作为心脑血管疾病一级预防的一种方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Frank's Sign: A Link Between Dermatovenerology, Cardiac Pathology, and Neurology.

Dear Editor, Although some of my colleagues may find this surprising, as a neurologist, I have noticed many connections between dermatology and neurology. Neurological and dermatological signs and symptoms are common in many clinical entities, especially in the so-called phakomatoses or neurocutaneous syndromes (Von Recklinghausen's disease type 1 and 2, Bourneville-Pringle syndrome, Sturge-Weber syndrome, Von Hippel-Lindau syndrome, Louis-Bar syndrome) (1). The terms "neurodermatitis" and "neurodermatology" also confirm the above. Inspection is the basis of every clinical examination and an integral part of both dermatological and neurological propaedeutics. Therefore, I would like to remind your readers of Frank's sign, another link between dermatology and neurology. Frank's sign is a diagonal earlobe crease (DELC) that extends backwards from the tragus at a 45-degree angle across the lobule to the auricular edge of the ear (Figure 1). It has been described as a dermatological marker for atherosclerosis. Frank's sign is named after Dr. Sanders T. Frank, who observed this crease in 20 patients with coronary artery disease and published his findings in The New England Journal of Medicine in 1973 (2). Although this sign has been known for more than 50 years, it is still not routinely employed in clinical practice. Histopathological examination of DELC-positive earlobes revealed myoelastofibrosis in the arterial vessel at the base of the earlobe, indicating that DELC is not a coincidental finding but is directly related to atherosclerosis (3). Following the finding of DELC in patients with coronary artery disease, numerous studies have confirmed the presence of DELC in peripheral vascular disease as well as cerebrovascular disease. I encountered the description of this sign as a student in the textbook of Internal Medicine in 1991 (4). This sign was also the subject of research by Croatian authors. In 1998, Mirić et al. found that a positive Frank's sign carried a higher risk of heart attack (5,6). In 2008, Glavić et al. found a statistically significant association between Frank's sign and an increase in intima media thickness (IMT) of the common carotid artery as a surrogate marker of atherosclerosis, thus confirming the hypothesis that Frank's sign is an uncontrollable risk factor for cerebrovascular disease (such as gender or age) (7). In clinical practice, earlobe inspection should be considered an integral part of the physical examination. In the case of a positive Frank's sign, a color Doppler ultrasound examination of the neck arteries and a cardiologist's examination are recommended. The determination of Frank's sign can be used as a method of primary prevention for cardiovascular and cerebrovascular diseases.

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