组织细胞坏死性淋巴结炎临床分析

Clinical investigation of patients with histiocytic necrotizing lymphadenitis

目的分析组织细胞坏死性淋巴结炎的临床资料。方法回顾性分析经病理证实的43例组织细胞坏死性淋巴结炎患者的临床特点和治疗过程、预后。结果 43例患者的男女发病率为1:1.15,所有患者均有颈部淋巴结肿大,77%患者伴有发热。20例行糖皮质激素治疗,13例未予药物干预,8例予消炎、止痛等对症治疗,2例手术清扫颈部肿大淋巴结。5例并发感染或自身免疫性疾病,其中2例死亡。随访22例中有5例复发,再次激素治疗有效。结论组织细胞坏死性淋巴结炎的临床表现、实验室和影像检查缺乏特异性,淋巴结活检病理检查可明确诊断。可并发自身免疫性疾病,有必要定期监测免疫功能和随访。

OBJECTIVE To evaluatet he clinicopathologic characteristics of histiocytic necrotizing lymphadenitis. METHODS The clinical data of 43 patients with histiocytic necrotizing lymphadenitis proved by pathology were reviewed retrospectively. RESULTSThe male-female ratio was 1：1.15. All patients had cervical lymphadenopathy,and 58% of them had bilateral lymphnode involvement, 77% of them had prolonged fever,while sore throat, fatigue, erythematous rashes, elevated ESR（82%） and CRP（61%）, leucopenia（44%） were the most common findings. CT scans demonstrated multiple and string-of-beads lymph notes. Twenty patients were treated with glucocorticoids, while 13 patients achieved remission of symptoms spontaneously and 8 received symptomatic treatment. Five of 22 telephone followed-up patients had a recurrence and glucocorticoids still had efficacy. Another 5 patients had intercurrent diseases, and 2 of them died. CONCLUSION The histiocytic necrotizing lymphadenitis has no specific imaging, laboratory and clinical findings. Biopsy of the cervical lymph nodes is the only way to make a definite diagnosis. It could be companied with autoimmune disease, so long-term follow-up is needed.