PDF(Pubmed)
Abstract：
OBJECTIVE: To analyze the clinical data of histiocytic necrotizing lymphadenitis(HNL), comparing the similarities and differences between children and adults, to deepen the understanding of the disease by clinical physicians, and to improve diagnostic rate and reduce misdiagnosis and mistreatment.
METHODS: The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted, and the clinical features, laboratory examinations, pathological features, treatments with antibiotics and glucocorticoids, and prognosis of histiocytic necrotic lymphadenitis were analyzed. Grouped based on age, the differences of clinical characteristics, laboratory tests, treatment, and prognosis between the children group (< 16 years old) and the adult group (≥16 years old) were compared.
RESULTS: Among the 81 enrolled patients, there were 42 males and 39 females. The median age was 21(14, 29) years, the median duration of disease was 20.0(13.0, 30.0) days, and the median length of hospital stay was 13.0 (10.0, 15.0) days. The first symptoms were fever, lymphadenopathy, and both. All the patients had enlarged lymph nodes with different parts and sizes, 96.3% (78 of 81) of the patients had cervical lymphadenopathy, 50.6% (41 of 81) had bilateral cervical lymphadenopathy, 55.6% (45 of 81) had supraclavicular, axillary or inguinal lymphadenopathy, and the median lymph node diameter was 20.0(20.0, 30.0) mm. Only one patient had no fever, the other 80 patients had fever, the median peak body temperature was 39.0(38.0, 39.8) ℃. Accompanying symptoms: rash (8.6%, 7/81), fatigue (34.6%, 28/81), night sweating (8.6%, 7/81), chills (25.3%, 25/81), muscle soreness (13.6%, 11/81), and joint pain (6.2%, 5/81). There were 17 cases (21.0%, 17/81) of hepatosplenomegaly, of which 12 cases (70.6%, 12/17) were splenomegaly. 68.8%(55/80) of patients had a decrease in white blood cell (WBC) count, with 47.5%(38/80)increased in lymphocyte(LY)proportion, 53.4%(39/73) increased in high-sensitivity C-reactive protein(CRP), 79.2%(57/72) increased in erythrocyte sedimentation rate(ESR), 22.2%(18/81) increased in alanine transaminase(ALT), 27.2%(22/81) elevated in aspartate transaminase(AST), and 81.6%(62/76) elevated in lactate dehydrogenase(LDH). All the 81 patients underwent lymph node biopsy, and 77.8%(63/81) of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared, and 16.0%(13/81) of the lymph nodes were still in existence, hyperplasia and normal lymph node were 1.2%(1/81) respectively, and 3.7%(3/81) had normal lymph node structures. Immunohistochemical staining was performed in 67 cases. The percentages of CD3+ and CD68(KP1)+ were respectively 97.0%(65/67), and MPO+ were 94.0%(63/67). In the study, 51 patients (63.0%, 51/81) were treated with glucocorticoid therapy after diagnosis. The median time for temperature to return to normal was 1.0(1.0, 4.0) days after glucocorticoid therapy. when the glucocorticoid treatment worked best, the body temperature could drop to normal on the same day. There were significant differences in length of stay, predisposing factors, chills, the rate of increase in high-sensitivity CRP, antibiotic and glucocorticoid treatment between the adults and children groups (P < 0.05).
CONCLUSIONS: In clinical practice, if there are cases with unexplained fever, superficial lymph node enlargement, and reduced white blood cells as clinical characteristics, and general antibiotics treatment is ineffective, histiocytic necrotic lymphadenitis should be considered. Lymph node biopsy should be performed as early as possible to clarify the diagnosis, reduce misdiagnosis and mistreatment, and symptomatic treatment should be the main treatment. Glucocorticoids therapy has a definite therapeutic effect.
METHODS: The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted, and the clinical features, laboratory examinations, pathological features, treatments with antibiotics and glucocorticoids, and prognosis of histiocytic necrotic lymphadenitis were analyzed. Grouped based on age, the differences of clinical characteristics, laboratory tests, treatment, and prognosis between the children group (< 16 years old) and the adult group (≥16 years old) were compared.
RESULTS: Among the 81 enrolled patients, there were 42 males and 39 females. The median age was 21(14, 29) years, the median duration of disease was 20.0(13.0, 30.0) days, and the median length of hospital stay was 13.0 (10.0, 15.0) days. The first symptoms were fever, lymphadenopathy, and both. All the patients had enlarged lymph nodes with different parts and sizes, 96.3% (78 of 81) of the patients had cervical lymphadenopathy, 50.6% (41 of 81) had bilateral cervical lymphadenopathy, 55.6% (45 of 81) had supraclavicular, axillary or inguinal lymphadenopathy, and the median lymph node diameter was 20.0(20.0, 30.0) mm. Only one patient had no fever, the other 80 patients had fever, the median peak body temperature was 39.0(38.0, 39.8) ℃. Accompanying symptoms: rash (8.6%, 7/81), fatigue (34.6%, 28/81), night sweating (8.6%, 7/81), chills (25.3%, 25/81), muscle soreness (13.6%, 11/81), and joint pain (6.2%, 5/81). There were 17 cases (21.0%, 17/81) of hepatosplenomegaly, of which 12 cases (70.6%, 12/17) were splenomegaly. 68.8%(55/80) of patients had a decrease in white blood cell (WBC) count, with 47.5%(38/80)increased in lymphocyte(LY)proportion, 53.4%(39/73) increased in high-sensitivity C-reactive protein(CRP), 79.2%(57/72) increased in erythrocyte sedimentation rate(ESR), 22.2%(18/81) increased in alanine transaminase(ALT), 27.2%(22/81) elevated in aspartate transaminase(AST), and 81.6%(62/76) elevated in lactate dehydrogenase(LDH). All the 81 patients underwent lymph node biopsy, and 77.8%(63/81) of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared, and 16.0%(13/81) of the lymph nodes were still in existence, hyperplasia and normal lymph node were 1.2%(1/81) respectively, and 3.7%(3/81) had normal lymph node structures. Immunohistochemical staining was performed in 67 cases. The percentages of CD3+ and CD68(KP1)+ were respectively 97.0%(65/67), and MPO+ were 94.0%(63/67). In the study, 51 patients (63.0%, 51/81) were treated with glucocorticoid therapy after diagnosis. The median time for temperature to return to normal was 1.0(1.0, 4.0) days after glucocorticoid therapy. when the glucocorticoid treatment worked best, the body temperature could drop to normal on the same day. There were significant differences in length of stay, predisposing factors, chills, the rate of increase in high-sensitivity CRP, antibiotic and glucocorticoid treatment between the adults and children groups (P < 0.05).
CONCLUSIONS: In clinical practice, if there are cases with unexplained fever, superficial lymph node enlargement, and reduced white blood cells as clinical characteristics, and general antibiotics treatment is ineffective, histiocytic necrotic lymphadenitis should be considered. Lymph node biopsy should be performed as early as possible to clarify the diagnosis, reduce misdiagnosis and mistreatment, and symptomatic treatment should be the main treatment. Glucocorticoids therapy has a definite therapeutic effect.
摘要：
目的:分析组织细胞坏死性淋巴结炎(HNL)的临床资料,比较儿童和成人之间的异同，为了加深临床医生对这种疾病的认识，提高诊断率，减少误诊误治。
方法：收集北京大学第一医院2010年1月至2023年8月活检确诊的组织细胞坏死性淋巴结炎住院患者的临床资料。和临床特征，实验室检查,病理特征,用抗生素和糖皮质激素治疗，并对组织细胞坏死性淋巴结炎的预后进行分析。按年龄分组,临床特征的差异，实验室测试,治疗,比较儿童组(<16岁)和成人组(≥16岁)的预后。
结果：在81名患者中，有42名男性和39名女性。中位年龄为21(14,29)岁,中位病程为20.0(13.0,30.0)天,中位住院时间为13.0(10.0,15.0)天。最初的症状是发烧，淋巴结病，和两者。所有患者均有不同部位和大小的肿大淋巴结，96.3%（78/81）的患者有颈部淋巴结肿大，50.6%（81个中的41个）有双侧颈部淋巴结肿大，55.6％（81个中的45个）患有锁骨上，腋窝或腹股沟淋巴结病，中位淋巴结直径为20.0（20.0，30.0）mm。只有一个病人没有发烧,其他80名患者发烧，中位峰值体温为39.0(38.0,39.8)℃。伴随症状：皮疹（8.6%，7/81),疲劳(34.6%，28/81），盗汗(8.6%,7/81),发冷(25.3%，25/81),肌肉酸痛（13.6%，11/81),和关节痛（6.2%，5/81）。有17例（21.0%，17/81）肝脾肿大，其中12例(70.6%，12/17）为脾肿大。68.8%(55/80)的患者白细胞(WBC)计数降低,淋巴细胞(LY)比例增加47.5%(38/80)，53.4%(39/73)高敏C反应蛋白(CRP)升高,红细胞沉降率（ESR）增加79.2％（57/72），22.2%（18/81）增加丙氨酸转氨酶（ALT），天门冬氨酸转氨酶（AST）升高27.2%（22/81），乳酸脱氢酶（LDH）升高81.6%（62/76）。81例患者均行淋巴结活检,77.8%(63/81)的患者显示大部分淋巴结结构被破坏或消失，16.0%(13/81)的淋巴结仍然存在，增生和正常淋巴结分别为1.2%(1/81),3.7%(3/81)的淋巴结结构正常。67例进行免疫组织化学染色。CD3+和CD68(KP1)+的百分比分别为97.0%(65/67),MPO+为94.0%(63/67)。在研究中,51例患者（63.0%，51/81）在诊断后接受糖皮质激素治疗。糖皮质激素治疗后，温度恢复正常的中位时间为1.0（1.0，4.0）天。当糖皮质激素治疗效果最好时，体温可能在同一天下降到正常。住院时间有显著差异，诱发因素,发冷,高敏CRP的增长率，抗生素和糖皮质激素治疗在成人组和儿童组之间存在差异(P<0.05)。
结论：在临床实践中，如果有不明原因的发烧病例，浅表淋巴结肿大，白细胞减少作为临床特征，一般抗生素治疗无效，应考虑组织细胞坏死性淋巴结炎。应尽早进行淋巴结活检以明确诊断，减少误诊误治,对症治疗应该是主要的治疗方法。糖皮质激素治疗有一定的治疗效果。
方法：收集北京大学第一医院2010年1月至2023年8月活检确诊的组织细胞坏死性淋巴结炎住院患者的临床资料。和临床特征，实验室检查,病理特征,用抗生素和糖皮质激素治疗，并对组织细胞坏死性淋巴结炎的预后进行分析。按年龄分组,临床特征的差异，实验室测试,治疗,比较儿童组(<16岁)和成人组(≥16岁)的预后。
结果：在81名患者中，有42名男性和39名女性。中位年龄为21(14,29)岁,中位病程为20.0(13.0,30.0)天,中位住院时间为13.0(10.0,15.0)天。最初的症状是发烧，淋巴结病，和两者。所有患者均有不同部位和大小的肿大淋巴结，96.3%（78/81）的患者有颈部淋巴结肿大，50.6%（81个中的41个）有双侧颈部淋巴结肿大，55.6％（81个中的45个）患有锁骨上，腋窝或腹股沟淋巴结病，中位淋巴结直径为20.0（20.0，30.0）mm。只有一个病人没有发烧,其他80名患者发烧，中位峰值体温为39.0(38.0,39.8)℃。伴随症状：皮疹（8.6%，7/81),疲劳(34.6%，28/81），盗汗(8.6%,7/81),发冷(25.3%，25/81),肌肉酸痛（13.6%，11/81),和关节痛（6.2%，5/81）。有17例（21.0%，17/81）肝脾肿大，其中12例(70.6%，12/17）为脾肿大。68.8%(55/80)的患者白细胞(WBC)计数降低,淋巴细胞(LY)比例增加47.5%(38/80)，53.4%(39/73)高敏C反应蛋白(CRP)升高,红细胞沉降率（ESR）增加79.2％（57/72），22.2%（18/81）增加丙氨酸转氨酶（ALT），天门冬氨酸转氨酶（AST）升高27.2%（22/81），乳酸脱氢酶（LDH）升高81.6%（62/76）。81例患者均行淋巴结活检,77.8%(63/81)的患者显示大部分淋巴结结构被破坏或消失，16.0%(13/81)的淋巴结仍然存在，增生和正常淋巴结分别为1.2%(1/81),3.7%(3/81)的淋巴结结构正常。67例进行免疫组织化学染色。CD3+和CD68(KP1)+的百分比分别为97.0%(65/67),MPO+为94.0%(63/67)。在研究中,51例患者（63.0%，51/81）在诊断后接受糖皮质激素治疗。糖皮质激素治疗后，温度恢复正常的中位时间为1.0（1.0，4.0）天。当糖皮质激素治疗效果最好时，体温可能在同一天下降到正常。住院时间有显著差异，诱发因素,发冷,高敏CRP的增长率，抗生素和糖皮质激素治疗在成人组和儿童组之间存在差异(P<0.05)。
结论：在临床实践中，如果有不明原因的发烧病例，浅表淋巴结肿大，白细胞减少作为临床特征，一般抗生素治疗无效，应考虑组织细胞坏死性淋巴结炎。应尽早进行淋巴结活检以明确诊断，减少误诊误治,对症治疗应该是主要的治疗方法。糖皮质激素治疗有一定的治疗效果。
