小儿亚急性坏死性淋巴结炎45例临床分析

Clinical analysis of 45 cases with subacute necrotizing lymphadenitis in children

目的探讨SNL的临床特征和相关实验室检查特点,以提高对儿童SNL的认识,减少误诊。方法回顾性分析45例SNL患儿的临床资料。结果本组45例患儿经淋巴结活检确诊为SNL;以学龄儿童为主,男女之比约为2.2:1;临床表现有发热(44例),淋巴结大(45例),伴有肝大和(或)脾肿大(10例)、多形性皮疹(5例);实验室检查多数患儿白细胞总数减少(38例)、C反应蛋白增高,红细胞沉降率增快、LDH升高;急性期多有病毒及支原体感染;其中1例合并系统性红斑狼疮,1例4个月后诊断为SLE,复发4例,其余患儿预后良好。结论 SNL属良性自限性疾病,糖皮质激素治疗有效,预后多良好;对不明原因发热伴淋巴结大患儿,应早期行淋巴结活检以明确诊断。

Objective To investigate clinical characteristics and related laboratory findings of SNL in children in order to improve the knowledge level of this disease and lessen its misdiagnosis. Methods The clinical materials of 45 SNL children were analyzed retrospeetively. Results The diagnosis of the 45 patients were confirmed as SNL by lymph node biopsy;mosl of them were school-age children with male-female ratio of 2.2 ： 1.The main clinical symptoms were fever（97.8%）,lym phadeneetasis（100%）,aecompanied with hepatomegalia and/or splenomegalia（22.2%） and pleomorphism erythra（11.1%）. Total leucocyte count decreased, C-reactive protein, erythroeyte sedimentation rate elevated and LDH increased in most of them.Infeetde with virus and mycoplasma was common in acute stage.One case combined and one ease developed SLE;four eases relapsed and the rest recovered well. Conclusion Subaeute neerotizing lymphanenitis is a benign and self- limiting disease,and glueocorticoid therapy is effective.Most of them have a good prognosis.For those with fever of unknown origin combined with lymphadenectasis are suggested to have an early lymph node biopsy in addition to related laboratory ,examination.