儿童组织细胞坏死性淋巴结炎70例临床分析及淋巴结活检的意义  

Clinical analysis of 70 children with histiocytic necrotizing lymphadenitis and significance of lymph node biopsy

作　　者：李芳芳[1] 赵林胜[2] 李崇巍[1] Li Fangfang;Zhao Linsheng;Li Chongwei(Department of Rheumatology and Immunology,Tianjin Children′s Hospital,Tianjin 300074,China;Department of Pathology,Tianjin Children′s Hospital,Tianjin 300074,China)

机构地区：[1]天津市儿童医院风湿免疫科,天津300074 [2]天津市儿童医院病理科,天津300074

出　　处：《中华实用儿科临床杂志》2021年第17期1325-1327,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的观察组织细胞坏死性淋巴结炎在儿童各年龄段的分布比例,评估糖皮质激素及羟氯喹治疗效果,评价淋巴结活检的意义。方法对天津市儿童医院2010年12月至2019年8月经淋巴结活检确诊的70例病历完整的患儿资料进行回顾性分析,总结治疗经验及预后。结果儿童组织细胞坏死性淋巴结炎好发于7~12岁儿童,男女发病比例为1.12∶1.00,但13岁以上男女比例为0.6∶1.0;18.6%(13例)患儿淋巴结活检术后病情缓解;35例应用非甾体抗炎药,其中仅10例(14.2%)单予非甾体类抗炎药后好转,其余联合糖皮质激素治疗后好转;激素治疗效果欠佳的4例患儿,联合羟氯喹后改善。结论儿童组织细胞坏死性淋巴结炎好发于学龄期儿童,男童比例略高,但13岁以上发病中以女童居多。淋巴结活检仍是诊断的金标准,且有利于病情缓解。病程可呈自限性,对于非甾体抗炎药治疗效果欠佳者,建议加用糖皮质激素治疗;羟氯喹可联合用于激素减量困难的难治性病例。Objective To observe the distribution ratio of histiocytic necrotizing lymphadenitis(HNL)in the age of children,evaluate glucocorticoids and Hydroxychloroquine therapeutic effects,evaluate the meaning of lymph node excisional biopsy.Methods The data of 70 cases of patients with the lymph node excisional biopsy in Tianjin Children′s Hospital from December 2010 to August 2019 were retrospectively analyzed.and summarized the treatment experience and prognosis.Results HNL mostly occurs in children 7-12 years old.The male-female ratio was 1.12∶1.00,but over 13 years old was 0.6∶1.0.Eighteen point one six percent(13 cases)of HNL was relieved after the lymph node excisional biopsy.Thirty-five cases were treated with non-steroidal anti-inflammatory drugs(NSAIDs),and only 10 cases(14.2%)were improved with NSAIDs alone and the rest were improved in combination with glucocorticoids.Four patients with ineffective glucocorticoids therapy were improved in combination with Hydroxychloroquine.Conclusion HNL in children was more common in school-age children.For children under 13 years old,the incidence among boys is slightly higher than that among girls;for children above 13 years old,the incidence among boys is slightly lower than that among girls.Lymph node biopsy is still the gold standard for diagnosis and is conducive to remission.The course of disease is self-limited,for the cases that NSAIDs is poor,the glucocorticoid treatment should be used.For refractory cases,combined Hydroxychloroquine treatment can be used.

关 键 词：淋巴结炎 活检 儿童 羟氯喹 

分 类 号：R725.5[医药卫生—儿科]