小儿亚急性坏死性淋巴结炎的病因及特征

THE ETIOLOGY AND CHARACTERS OF SUBACUTE NECROTIZING LYMPHADENITIS IN CHILDREN

目的探讨亚急性坏死性淋巴结炎(SNL)的病因及临床特征,提高对儿童SNL的认识,减少误诊。方法回顾分析28例SNL病儿的临床资料。结果本组28例病儿经淋巴结活检确诊为SNL;其中85.7%病儿冬春及初夏季节发病,以学龄儿童为主,男女之比约为3∶1;临床表现均有发热、淋巴结大,可伴有肝大和(或)脾大(31.6%)、多形性皮疹(14.3%);实验室检查多数病儿白细胞总数减少、红细胞沉降率增快、LDH升高;急性期多有病毒及支原体感染;病理特点为淋巴结广泛的凝固性坏死伴组织细胞反应性增生;其中1例发展为系统性红斑狼疮(SLE),复发2例,其余病儿预后良好。结论对不明原因发热伴淋巴结大病儿,除行相关实验室检查外,应早期行淋巴结活检以明确诊断。SNL属自限性疾病,预后多良好,亦有复发,少数发展为SLE,应长期随访。

Objective To explore the causes and clinical characteristics of subacute necrotizing lymphadenitis （SNL） in children in order to improve the knowledge of this disease and lessen its misdiagnosis. Methods The clinical materials of 28 SNL children were analyzed retrospectively. Results The diagnosis of the 28 patients was confirmed as SNL by lymph node biopsy; 85.7% of them, mainly school-age children with male-female ratio of 3 ： 1, occurred in winter, spring or early summer. Their clinical manifestations were fever, lymphadenectasis, accompanied with hepatomegalia and/or splenomegalia（31. 6%） and pleomor-phism erythra （14.3%）. Total leucocyte count decreased, erythrocyte sedimentation rate elevated and LDH increased in most of them. Infected with virus and mycoplasma was common in acute stage. Pathological features of the lymph nodes were wide coagulation necrosis and histiocytic reactive hyperplasia, in which, one case developed systemic lupus erythematosus, and two relapsed, the rest recovered well. Conclusion For those with fever of unknown origin combined with lymphadenectasis is suggested to have an early lymph node biopsy in addition to related laboratory examination. Subacute necrotizing lymphanenitis is a self-limiting disorder, most with a good prognosis, but some relapse and few develop systemic lupus erythematosus, a long-term follow-up is needed.