72例儿童组织细胞性坏死性淋巴结炎临床分析  

Clinical analysis of 72 children with histiocytic necrotizing lymphadenitis

作　　者：刘丽艳[1] 王平[1] 刘红彦 宋双双 李继安 LIU Liyan;WANG Ping;LIU Hongyan;SONG Shuangshuang;LI Ji’an(Department of Infectious Diseases,Children’s Hospital Affiliated to Shandong University,Jinan 250000,Shandong,)

机构地区：[1]山东大学附属儿童医院感染性疾病科,山东济南250000

出　　处：《中国现代医生》2024年第21期26-29,74,共5页China Modern Doctor

基　　金：山东省济南市卫生健康委员会科技计划项目(2022-2-160)。

摘　　要：目的探讨儿童组织细胞性坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)的临床特征、治疗及预后。方法回顾性分析2019年1月至2023年12月山东大学附属儿童医院感染性疾病科诊治的72例HNL患儿的临床资料,分析其临床症状、实验室检查、影像学检查、病理表现、治疗及随访情况。结果72例患儿中男49例、女23例。发病年龄3~15岁,其中55例发病年龄为8~13岁,占76.4%;首次发病病程为2~60d,平均15d。所有患儿均有发热和淋巴结肿大,除1例患儿仅出现腹腔淋巴结病变外,其余患儿均有颈部淋巴结受累。少数患儿病程中出现皮疹、关节肿痛、无菌性脑膜炎等表现,1例患儿合并冠状动脉和颈静脉扩张。在疾病急性期,患儿多出现白细胞和血红蛋白降低、红细胞沉降率和乳酸脱氢酶升高。71例患儿使用糖皮质激素治疗,其中69例疗程为8~12周。初诊病例中随访时间最长的已近5年,除1例患儿进展为皮肤红斑狼疮外,没有病例复发或进展为其他免疫性疾病。结论儿童HNL好发于学龄期,总体发病率男童高于女童。HNL患儿多出现颈部淋巴结肿大,极少数仅累及深部淋巴结;也可引起血管病变。确诊后使用糖皮质激素治疗2~3个月可减少复发、阻止疾病进展。Objective To investigate the clinical features,treatment and prognosis of children with histiocytic necrotizing lymphadenitis(HNL).Methods The clinical data of 72 children with HNL diagnosed and treated in the Department of Infectious Diseases,Children’s Hospital Affiliated to Shandong University from January 2019 to December 2023 were reviewed.The clinical symptoms,laboratory examination,imaging examination,pathological findings,treatment and follow-up were retrospectively analyzed.Results Among the 72 children,49 were males and 23 were females.The age was 3 to 15 years old,of which 55 cases(76.4%)ranged from 8 to 13 years.The duration of the first onset was 2-60 days,with an average of 15 days.All the children had fever and lymph node enlargement.Only abdominal lymph node lesions were present in 1 case,and cervical lymph nodes were involved in the rest.In the course of the disease,a few of the children had rash,joint swelling and pain and aseptic meningitis.One patient had coronary artery and jugular dilatation.In the acute stage of the disease,most children had decreased white blood cells and hemoglobin,increased erythrocyte sedimentation rate and lactate dehydrogenase.71 cases were treated with glucocorticoid,and 69 cases were treated for 8-12 weeks.The longest follow-up of the newly diagnosed cases has been nearly 5 years,except for one patient who developed cutaneous lupus,no case has recurred or progressed to other immune diseases.Conclusion Children HNL is more common in school-age children.The overall incidence is higher in boys than girls.Most children with HNL present with cervical lymph node enlargement,and very few patients only involve deep lymph nodes.It can also cause vascular lesions.Treatment with glucocorticoids for 2 to 3 months after diagnosis may reduce recurrence and prevent disease progression.

关 键 词：组织细胞性坏死性淋巴结炎 儿童 临床特征 预后 

分 类 号：R454.2[医药卫生—治疗学]