组织细胞坏死性淋巴结炎42例临床分析  

Clinical Analysis of 42 Cases of Histiocytic Necrotizing Lymphadenitis

作　　者：吴岑[1] 栾九松[1] 周晓明[1] 谷秀[1] 

机构地区：[1]中国医科大学附属盛京医院呼吸科,辽宁沈阳110004

出　　处：《四川医学》2017年第5期510-513,共4页Sichuan Medical Journal

摘　　要：目的探讨组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)的临床特点。方法以病理确诊为组织细胞坏死性淋巴结炎为诊断标准,回顾性分析我院从2007年至2015年收治的42例HNL患者的临床资料。结果共纳入42例病理确诊病例,男12例,女30例,平均年龄(27.4±12.0)岁。主要临床表现包括发热(97.6%)、淋巴结肿大(100%)、淋巴结压痛(69.0%)、皮疹(40.5%)和出现上感前驱症状(40.5%)。实验室检查主要特点是85.7%伴有白细胞降低,42.9%抗核抗体阳性或弱阳性。前期均接受抗生素治疗,抗生素治疗无效后,27例(66.7%)改为强的松0.5~1.0mg/(kg·d)治疗,2~5d后体温降至正常,14例(33.3%)对症治疗后缓解,1例(2.4%)自行缓解,3例(7.1%)复发。结论 HNL以持续性发热、疼痛性浅表淋巴结肿大和白细胞降低为特征,病理特征为出现大量的核碎裂的组织细胞和增生的单个核细胞。抗感染治疗无效,部分患者可以自愈,激素治疗有效。部分患者可合并或进展为风湿免疫系统疾病,需对患者随访1~2年,尤其是病理结果为增生型和坏死型的患者较病理结果为黄色瘤型的患者复发的可能性更大,更需对此重视。Objective To study the clinical characteristics of histiocytic necrotizing lymphadenitis （HNL）. Methods The pathological diagnosis of histioeytic necrotizing lymphadenitis was taken as diagnostic criteria. The clinical data of 42 cases of HNL patients received in our hospital from 2007 to 2015 were analyzed retrospectively. Results 42 cases of pathologically diag- nosed cases were included ,which consisted of 12 males and 30 females with a mean age of（27.4 ± 12.0）. The main clinical mani- festations included fever （ 97.6% ）, lymphadeneetasis （ 100% ）, lymph node tenderness （ 69.0% ）, rash （40. 5% ） and precursory symptoms of upper respiratory infection（40. 5% ）. The laboratory examination results showed that 85.7% patients were accompa- nied by leukopenia and 42.9% patients had positive or weakly positive antinuclear antibody. Patients were all received antibiotic therapy at early stage. After the ineffective treatment of antibiotics,27 cases （66. 7 % ） were changed to 0. 5 ± 1.0 mg/kg Prednisone every day and their body temperature dropped to normal after 2 -5 days, 14 cases （33.3%）remitted after symptomatic treatment and 1 case （ 2.4% ） got spontaneous remission, but 3 cases （ 7. 1% ） relapsed. Conclusion HNL is characterized by persistent fe- ver, painful superficial lymphadenectasis and leukopenia. Its pathological characteristics includes emergence of histocytes with kary- orrhexis and proliferating mononuclear cells. Anti-infective therapy is ineffective, but some patients can get spontaneous remission and glucoeorticoid is efficacious. Some patients can combine with or progress to rheumaimmune systemic diseases, so patients need to be followed up for 1-2 years. In especial,patients with pathological results of proliferative or necrotic type have higher possibility of relapse than patients with pathological results of xanthoma type,who need more attention.

关 键 词：组织细胞坏死性淋巴结炎 诊断 治疗 

分 类 号：R551.2[医药卫生—血液循环系统疾病]