儿童亚急性坏死性淋巴结炎临床分析

Clinical analysis with subacute necrotizing lymphadenitis

目的 探讨亚急性坏死性淋巴结炎（SNL）的病因、临床特征和实验室检查特点,以提高对SNL的认识.方法 回顾性分析14例经病理确诊的SNL患儿的临床资料.结果 发病以学龄儿为主,平均年龄（10.4±2.9）岁,男女之比1.8∶1.临床表现主要为淋巴结肿大、压痛14例（100%）,发热13例（92.9%）,皮疹、肝脾肿大各2例（14.3%）.14例患儿白细胞计数（2.3～7.4）×109/L,平均（3.90±0.35）×109/L,其中白细胞降低10例（71.4%）,未见白细胞升高;12例C反应蛋白检测,8例轻度升高（10～30mg/dl）;13例患儿行血沉检查,11例（82.6%）高于正常水平（20mm/h）,平均40mm/h,最高达70mm/h;8例患儿行抗核抗体检测,2例阳性;12例患儿行抗EB病毒抗体检查4例阳性,11例行血支原体-IgM检查1例阳性,6例行柯萨奇病毒抗体检测1例阳性,柯萨奇、EB病毒混合感染1例;淋巴结组织活检可见大小不一的碎屑状坏死,坏死周围可见组织细胞增生,很少出现浆细胞、嗜中性粒细胞和嗜酸性粒细胞;淋巴结EB病毒DNA检测阴性.8例患儿给予强的松1.5～2.0mg/（kg·d）治疗,效果显著.病情稳定后复查血常规,5例白细胞恢复正常;复发1例,其余患儿预后良好.结论 对于不明原因发热伴淋巴结肿大、疼痛的患儿,应尽早行淋巴结活检确诊,该病呈自限性,糖皮质激素治疗有效,但少数有复发,应长期随访.无证据证明EB病毒在SNL的发病中起作用,白细胞恢复正常可作为病情好转的指标之一.

Objective To investigate etiological factors, clinical characteristic and related laboratory findings of subacute necrotizing lymphadenitis and improve the acknowledgement of subacute necrotizing lymphadenitis. Methods We analyzed 14 cases of subacute necrotizing lymphadenitis who had been diagnosed by lymph node biopsy retrospectively. Results The most of patients were school children with mean age of 10.4 ± 2.9） years. The ratio of male to female was 1.8∶1 .The main clinical symptoms were that lymph nodes were swelling and pressing-pain in 14 cases （100%） and fever in 13 cases （92.9%）, rash in 2 cases （14.3%）,hepatosplenomegaly in 2 cases （14.3%）.The white blood cell count was （2.3 ～ 7.4） × 109/L in 14 cases and average count was （3.90 ± 0.35） × 109/L. The white blood cell count showed leukopenia in 10 cases （71.4%） and none showed heighten. Twelve cases were tested by CRP and the result of 8 cases elevated slightly （10 ～ 30 mg/dl）. Thirteen cases underwent ESR examination and the result of 11 cases showed higher than that of normal level （20mm/h）（82.6%）. The average ESR risen value was 40mm/h and topmost value was 70 mm/h. Eight cases underwent anti-nuclear antibody test and 2 cases of them were positive. Twelve cases underwent EB virus antibody test and 4 cases of them were positive. Eleven cases underwent blood Mycoplasma-IgM examination and one of them was positive. Six cases underwent coxsackie virus antibody and one of them was positive.Coxsackie and EB virus infected in one case. Lymph node biopsy was found necrotic fragments in different sizes. The cellular hyperplasia was found around the necrotic area and plasma cells, neutrophils, and eosinophils were found rarely in these areas. The DNA of EB virus was negative in lymph nodes. Eight cases of all were treated by prednisone and effect showed well 1.5 ～ 2.0 mg/（kg·d））. One of all was recurrence and the rest recovered well. Blood routine examination was used when they were under a stable condition, five cases of them showed normal white blood cells. Conclusion Those with fever of unknown origin combined with lymphadenectasis are suggested to have an early lymph node biopsy. The process is self-limited and glucocorticoid therapy is effective to those impatients. The long-term follow up is required as recurrence and development of SLE have reported. EB virus was not an etiological factor of SNL. Leucocyte can be used as one of the indicators of improvement. Keywords：Subacute necrotizing