儿童亚急性坏死性淋巴结炎病因及临床特征

Analysis of the etiology and the clinical characteristic of subacute necrotizing lymphadenitis in children

目的探讨亚急性坏死性淋巴结炎(SNL)的病因、实验室检查及临床特征,提高对儿童SNL的认识,减少误诊,合理治疗。方法结合文献资料,回顾分析13例SNL患儿的临床资料。结果本组13例患儿经淋巴结活检确诊为SNL,以学龄期儿童为主,中位年龄10.3岁,男女之比约为2.3∶1;临床特征表现为发热、浅表淋巴结肿大、白细胞及中性粒细胞减少(82%),可伴有肝或脾轻度肿大(30%);急性期多有病毒及支原体感染;免疫学检查:T细胞亚群测定显示CD4+/CD8+降低(63%);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;广谱抗生素治疗无效,复发1例,其余病儿预后良好。结论对不明原因发热伴淋巴结大的学龄患儿,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可能与病毒感染或变态反应有关,存在细胞免疫功能紊乱,病程多呈自限性,糖皮质激素治疗敏感,亦有复发,应长期随访。

Objective To investigate etiological factors, clinical characteristics and laboratory findings of childreng subacute necrotizing lymphadenitis（SNL）,so as to improve the knowledge of this disease and lessen its misdiagnosis and reasonable treatment. Methods The clinical manifestations and laboratory findings in the related literature of 13 SNL children were retrospectively viewed. Results The diagnosis of the 13 patients were confirmed as SNL by lymph node biopsy, Most of them were school - aged children, the median age is 10.3 years, the male - to - female ratio was 2.3： 1 ; Their clinical manifestations were fever,lymphadenectasis, total leucocyte and neutrophil count decreased, accompanied with hepatomegalia and/or splenomegalia slightly（38% ） ;Infected with virus and mycoplasma was common in acute stage;the CD4 ^＋/CD8^ ＋T lymphocytes ratio were declined on half of the patients by determination of T - lymphocyte Subgroup and observation of cellular immune function. Pathological features of the lymphnodes were wide coagulation necrosis and histiocytic reactive hyperplasia, therapy with the broad - spectrum antibiotics were ineffectual,in which, one 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,it is necessary to make a differential diagnosis to role, A possible association of virus infection and allergy with SNL, it is a self - limiting disorder, most with a good prognosis, glucocorticoids therapy was sensitive, but some relapse, so long - term follow - up is needed.