儿童组织细胞坏死性淋巴结炎21例临床特征及预后分析

doi:10.20274/j.cnki.issn.2025.04.009

Abstract

Abstract:

Objective To investigate the clinical features and prognostic factors, and analyze the treatment outcomes and follow-up results of histiocytic necrotizing lymphadenitis (HNL) in children, aiming to provide a basis for improving its early diagnosis and management. Methods The method of retrospective case analysis was adopted. The clinical data of 21 children with HNL who were diagnosed by lymphocytic biopsy and received treatment in the Department of Pediatrics, Shanxi Bethune Hospital from January 2018 to April 2025 were collected. Their clinical symptoms, laboratory test results, imaging findings, pathological results, treatment regimens, and follow-up information were analyzed to summarize the clinical characteristics and prognosis of HNL. Results Of the 21 patients, 10 were male and 11 were female (M∶F ratio 1∶1.1). The children's ages ranged from 5 to 13 years (9.86 ± 2.56 years). All patients presented with fever and lymphadenopathy. The laboratory findings included leukopenia in 11 cases (52.4%), elevated erythrocyte sedimentation rate (ESR) in 17 cases (81.0%), decreased hemoglobin in 3 cases (14.3%), elevated alanine amino-transferase in 4 cases (19.0%)，and elevated lactate dehydrogenase (LDH) in 16 cases (76.2%). All patients underwent cervical lymph node ultrasonography, which showed cervical lymph node enlargement, with an average size of (1.86 ± 0.42) cm. Lymph node biopsy was performed in all 21 cases. Pathological results indicated HNL, without pathological evidence of lymphoma or Epstein-Barr virus (EBV) infection. Regarding treatment, 6 cases (28.6%) achieved spontaneous remission without corticosteroid therapy, while 15 cases (71.4%) received corticosteroid treatment. Follow-up results revealed that 18 cases (85.7%) had no recurrence after the initial episode, while 3 cases (14.3%) experienced varying degrees of recurrence. None of the patients progressed to autoimmune diseases such as systemic lupus erythematosus (SLE). Conclusion Some of HNL cases can undergo spontaneous remission during the first episode, and the disease is sensitive to corticosteroids, generally leading to a favorable prognosis. However, it's important to watch for severe complications or the development of autoimmune diseases. Long-term follow-up is essential for preventing recurrence and disease progression.

Key words: Histiocytic necrotizing lymphadenitis, Clinical characteristics, Prognosis, Child

CLC Number:

R725.5

Li ZHANG, Yanfei YANG, Yanfen WANG. Clinical features and prognostic analysis of 21 cases of histiocytic necrotizing lymphadenitis in children[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(4): 324-329.

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References 22

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临床特征	n(%)	临床特征	n(%)
发热热峰		颈部淋巴结肿大
≥39 ℃	19（90.5）	双侧	12（57.1）
<39 ℃	2（9.5）	单侧	9（42.9）
热程		左侧	1（4.8）
≤1周	2（9.5）	右侧	8（38.1）
>1～2周	13（61.9）	合并腋窝淋巴结肿大	4（19.1）
>2周	6（28.6）	合并腹股沟淋巴结肿大	4（19.1）
淋巴结压痛	21（100.0）	皮疹	2（9.5）
淋巴结大小（x±s，cm）	1.86±0.42	肝大	1（4.8）
长径	2.52±0.76	脾大	3（14.3）
短径	1.19±0.38

指标	范围	异常值	检测例数	异常情况[n（%）]
白细胞计数	（2.07～5.40）×10⁹/L	<4×10⁹/L	21	11（52.4）
中性粒细胞计数	（0.98～3.45）×10⁹/L	<1.5×10⁹/L	21	7（33.3）
血红蛋白	110～145 g/L	<110 g/L（<6岁） <120 g/L（>6岁）	21	3（14.3）
血小板计数	(105～357)×10⁹/L	<100×10⁹/L	21	0（0.0）
C反应蛋白	1～57.2 mg/L	>8 mg/L	21	7（33.3）
降钙素原	0.05～0.71 μg/L	>0.5 μg/L	12	1（8.3）
红细胞沉降率	10～55 mm/h	>20 mm/h	21	17（81.0）
丙氨酸转移酶	7.5～160.4 IU/L	>50 IU/L	21	4（19.0）
乳酸脱氢酶	211.2～1 583 IU/L	>250 IU/L	21	16（76.2）
抗链球菌溶血素O	0.63～1 287.15 IU/mL	>150 IU/mL	15	7（46.7）
铁蛋白	90.5～2 236.94 μg/L	>336.2 μg/L	12	3（25.0）
结核菌素试验	-	阳性	21	0（0）
抗核抗体	-	阳性	8	3（37.5）
EB病毒IgM抗体	-	阳性	18	2（11.1）
巨细胞病毒IgM抗体	-	阳性	18	0（0）
白细胞介素-6	8.64～1 123.2 ng/L	>18.6 ng/L	9	7（77.8）
γ干扰素	2.23～10 000 ng/L	>21.9 ng/L	9	8（88.9）
白细胞介素-2	1～48.6 ng/L	>9.3 ng/L	9	1（11.1）
白细胞介素-4	1.2～102.6 ng/L	>9.5 ng/L	9	1（11.1）
补体C3	1～1.67 g/L	<0.7 g/L	21	0（0）
补体C4	0.26～0.55 g/L	<0.1 g/L	21	0（0）

指标	未使用激素（n=6）	使用激素（n=15）	t值	P值
红细胞沉降率（mm/h）	26.67±10.39	32.33±11.02	-1.11	0.294
C反应蛋白（mg/L）	24.54±5.28	15.53±18.69	1.63	0.122
γ干扰素（ng/L）	71.43±59.09	94.96±73.80	-0.79	0.660
白细胞介素-6（ng/L）	33.06±0.65	184.39±414.20	-0.97	0.370
血小板计数（×10⁹/L）	170.50±43.91	199.27±51.57	-1.21	0.245
铁蛋白（μg/L）	606.45±602.53	449.95±654.24	0.80	0.762
乳酸脱氢酶（IU/L）	312.88±70.92	429.95±160.55	-1.69	0.109
淋巴结大小（cm）	1.92±0.66	1.83±0.32	0.32	0.701
多发淋巴结[n（%）]	3（50.0）	2（13.3）	-	0.099
皮肤受累[n（%）]	0（0）	2（13.3）	-	1.000
抗核抗体阳性[n（%）]	0（0）	3（20.0）	-	0.535

指标	复发（n=3）	非复发（n=18）	t值	P值
红细胞沉降率（mm/h）	46.67±7.23	28.06±9.02	3.373	0.003
C反应蛋白（mg/L）	16.49±23.51	11.47±15.47	0.488	0.634
γ干扰素（ng/L）	97.00±30.56	86.43±78.04	0.228	0.864
白细胞介素-6（ng/L）	40.65±8.79	182.22±415.07	-0.578	0.660
血小板计数（×10⁹/L）	179.33±70.00	193.00±48.59	-0.428	0.674
铁蛋白（μg/L）	455.63±505.43	482.84±684.07	-0.065	0.951
乳酸脱氢酶（IU/L）	387.50±254.29	387.76±136.94	-0.003	0.998
淋巴结大小（cm）	2.32±0.68	1.78±0.34	2.220	0.039
多发淋巴结[n（%）]	1（33.3）	4（22.2）	-	1.000
皮肤受累[n（%）]	1（33.3）	1（5.6）	-	0.333
抗核抗体阳性[n（%）]	1（33.3）	2(11.1)	-	0.467
激素治疗[n（%）]	2(66.7)	13(72.2)	-	1.000

Clinical features and prognostic analysis of 21 cases of histiocytic necrotizing lymphadenitis in children

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