组织细胞坏死性淋巴结炎29例临床分析及文献复习

目的 探讨组织细胞坏死性淋巴结炎的临床特点和诊治方法.方法 回顾近10年我院收治的29例组织细胞坏死性淋巴结炎的临床表现、实验室检查结果和治疗效果.结果 29例病人男女比例为14:15,100%有淋巴结肿大,72.4%有发热,44.8%患者有咽痛、咳嗽等,超声发现脾肿大者占46.7%(7/15),肝功能异常者34.6%(9/26),白细胞降低者占39.3%(11/28),血沉增快者占59.1%(13/19),C反应蛋白升高者占66.7%(10/15),ANA阳性率9.1%(1/11),抗-EBV IgM阳性率3.3%(3/9),16例患者接受了皮质激素治疗,10例患者自行缓解,另有1例出院后复发而服用皮质激素、1例半年后诊断为成人斯提尔病、1例不除外合并结缔组织病.结论 本病临床表现无特异性,诊断依赖淋巴结活检,治疗以糖皮质激素为首选,部分病人可自愈.

Clinical analysis of 29 cases of histiocytic necrotizing lymphadenitis and literature review

Objective To investigate the clinical characteristic,treatment of histiocytic necrotizing lymphadenitis(HNL).Methods To review the clinical manifestation,laboratory examination results and curative effect of 29 cases of HNL admitted in our hospital in recent 10 years.Results The male female ratio was 14 ∶ 15.All patients had lymphadenectasis,72.4% of them were feverish,44.8% of them had respiratory symptoms such as sore throat and cough,ultrasound check found splenomegaly in 46.7% of patients(7/15),laboratory tests shew leucopenia in 39.3% patients(11/28),hepatic dysfunctions 34.6%(9/26),elevated erythrocyte sedimentation rate(ESR) in 59.1% patients(13/19),elevated C-reactive protein 66.7% patients(10/15),positive ratio of antinuclear antibody(ANA) is 9.1%(1/11),positive ratio of Anti-EBV IgM is 33.3%(3/9).16 of the patients accepted glucocorticoid therapy,other 10 cases spontaneously released,another one accepted glucocorticoid therapy because of recurrence after being discharged,one patient was diagnosed as adult onset still disease half a year later,one patient couldn’t be ruled out of complicating with connective tissue disease.Conclusions Without specific clinical manifestation,the diagnosis of HNL is dependent on lymph node biopsy.The first chosen of the treatment is the glucocorticoid,and some patients can spontaneous cure.