淋巴结活检在儿童淋巴瘤相关噬血细胞综合征筛查中的应用  

Value of lymph node biopsy in screening children with lymphoma-associated hemophagocytic syndrome

作　　者：文佳冰[1] 李勇[1] 肖雅玲[1] 黎明[1] 唐湘莲[1] Wen Jiabing;Li Yong;Xiao Yaling;Li Ming;Tang Xianglian(Department of General Surgery,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院普外二科,长沙410007

出　　处：《临床小儿外科杂志》2023年第3期267-271,共5页Journal of Clinical Pediatric Surgery

基　　金：2020年度湖南省临床医疗技术创新引导项目(2020SK50501)

摘　　要：目的探讨淋巴结活检在筛查儿童淋巴瘤相关噬血细胞综合征中的作用。方法回顾性分析湖南省儿童医院2012年1月1日至2021年12月31日临床诊断为噬血细胞性淋巴组织细胞增多症(hemophagocytic lymphohistiocytosis,HLH)的513例患儿以及808例非HLH但行淋巴结活检的患儿资料,将HLH患儿中行淋巴结活检的患儿纳入活检组(61例),未行淋巴结活检患儿纳入未活检组(452例),行淋巴结活检且结果为阴性的患儿纳入活检阴性组(56例),将808例非HLH患儿常规活检(包括淋巴结活检及其他各种脏器组织活检)确诊的淋巴瘤患儿纳入非HLH淋巴瘤组(73例)。比较HLH患儿与非HLH患儿活检淋巴瘤阳性率的差异,HLH患儿中活检组与未活检组在性别、年龄及病死率上的差异,HLH活检阴性组与非HLH淋巴瘤组在性别、年龄、脏器影像学异常、淋巴结/肿块组织大小上的差异。结果513例HLH患儿共61例行淋巴结活检,发现合并淋巴瘤5例;808例常规活检患儿发现淋巴瘤73例;HLH活检与常规活检发现淋巴瘤的概率差异无统计学意义(χ^(2)=0.049,P=0.825);HLH患儿活检组与未活检组年龄差异有统计学意义(t=2.024,P=0.043),性别、病死率差异无统计学意义(χ^(2)=0.966,P=0.326;χ^(2)=1.432,P=0.233);HLH患儿活检阴性组与非HLH淋巴瘤组患儿的性别构成差异无统计学意义(χ^(2)=4.490,P=0.503),但年龄构成、影像学异常、活检淋巴结(组织)大小差异均有统计学意义(t=4.297,P<0.001;χ^(2)=15.486,P<0.001;Z=8.354,P<0.001);结论HLH患儿行手术活检并未明显增加死亡风险,但活检阳性率偏低,应进一步完善活检指征;淋巴结大小及脏器影像学异常在非恶性肿瘤继发的HLH患儿与非HLH淋巴瘤患儿之间存在明显差异,提示二者可作为HLH患儿是否进一步完善淋巴瘤筛查的指征。Objective To explore the value of lymph node biopsy in screening children with lymphoma-associated hemophagocytic syndrome(HPS).Methods From January 1,2012 to December 31,2021,clinical data were retrospectively reviewed for 513 HPS children and 808 children with lymph node biopsy.They were divided into biopsy and non-biopsy groups while lymphoma-negative children with HLH biopsy were classified as biopsy-negative group and those with a diagnosis of lymphoma lymphoma group.The differences were compared in positive biopsy rate of lymphoma between HLH and non-HLH children.And the differences in gender,age and mortality were compared between biopsy and non-biopsy HLH groups.Also the differences in gender,age,organ imaging abnormalities and lymph node/tissue were compared between HLH biopsy-negative and lymphoma groups.Results A total of 61 lymph node/tissue biopsies were performed in 513 HLH children.Five cases of lymphoma were found and 73 cases of lymphoma detected in 808 children with routine biopsy during the same period.The probability of detecting lymphoma in HLH biopsy was no different from conventional biopsy(χ^(2)=0.049,P=0.825);difference in age existed between biopsy and non-biopsy groups(t=2.024,P=0.043).However,no significant difference existed in gender or mortality(χ^(2)=0.966,P=0.326;χ^(2)=1.432,P=0.233);no difference existed in gender composition between children with negative HLH lymph node biopsy and those with confirmed lymphoma.However,differences existed in age composition,imaging abnormalities and size of biopsy lymph nodes(tissues)(χ^(2)=4.49,P=0.503;t=4.297,P<0.001;χ^(2)=15.486,P<0.001;Z=8.354,P<.001).Conclusion Surgical biopsy in HLH children does not significantly elevate the risk of mortality.However,the positive rate of biopsy is low and biopsy indications should be further refined.There were significant differences in lymph node size and organ imaging abnormalities between HLH children secondary to non-malignant tumors and those with diagnosed lymphoma.It hints that the two may be e

关 键 词：淋巴结活检 噬血细胞综合征 噬血细胞性淋巴组织增多症 淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]