| Objective:The clinical data of histiocytic necrotizing lymphadenitis(HNL)in children were analyzed to clarify its clinical characteristics and guide the clinical diagnosis and treatment.,and to provide a basis for avoiding recurrence and improving prognosis.Methods:A retrospective analysis of the information of 86 cases of histiocytic necrotizing lymphadenitis confirmed by lymph node biopsy in the first hospital of Jilin University from July 2018 to January 2022 was conducted in this study.It includes the general data(age and gender),clinical manifestations,laboratory indicators,treatment and recurrence of the children during hospitalization.The data of the children who were grouped according to the days of fever before admission and whether there was recurrence were statistically analyzed,and the risk factors affecting the recurrence were discussed.Results:1.There were 86 HNL children aged 1～17 years,mainly school-age children,with a male to female ratio of 1.09:1.00.All the children had lymphadenopathy,mainly cervical lymphadenopathy(97.7%),most of which was accompanied by tenderness(76.7%).In up to 97.7% of children with fever,high fever is given priority to,other clinical manifestations were cough(31.4%),rash(22.1%),abdominal pain(10.5%),headache(9.3%),splenomegaly(7.0%),sore throat(5.8%),arthralgia(3.5%),oral ulcer(2.3%),hepatomegaly(1.2%).Laboratory tests showed that lactate dehydrogenase increased(95.3%),C-reactive protein increased(77.9%),erythrocyte sedimentation rate increased(76.7%),leukopenia(73.3%),absolute neutrophil count decreased(51.2%),anemia(39.5%),aspartate aminotransferase increased(39.5%),ferritin increased(39.1%),antinuclear antibody positive(38.4%),and alanine aminotransferase increased(24.4%);In acute stage,most patients were infected with mycoplasma(28.8%)and virus(22.1%).Among them,61.6% were treated with glucocorticoid,38.4% had spontaneous remission,and 12.8% had normal body temperature after lymph node resection and biopsy.A total of 9(10.5%)of the 86 patients relapsed,and 1(1.2%)was diagnosed as systemic lupus erythematosus(SLE)2 years later.Among the 86 cases,2 cases(2.3%)were secondary to SLE,which is still under long-term treatment,and the rest had a good prognosis.2.There were 49 cases in acute fever group and 35 cases in long-term fever group.The median number of ESR in long-term fever group was higher than that in acute fever group,and the median number of CRP in long-term fever group was lower than that in long-term fever group,with statistical significance(P<0.05).3.There were 9 cases in the recurrent group and 77 cases in the non-recurrent group.Univariate analysis showed that the proportion of rash and ANA positive in the recurrent group was higher than that in the non-recurrent group,and the median number of absolute neutrophil count was higher than that in the non-recurrent group,and the difference was statistically significant(P<0.05).Binary Logistic regression analysis showed that rash and ANA positive were independent risk factors for HNL recurrence in children.Inconclusion:1.The peak age of HNL in children is 7-12 years old,and Mycoplasma pneumoniae infection may be related to the onset of HNL.2.In clinical manifestations,the ESR of HNL children with long fever time is more obvious.3.Ultrasonography plays an important role in the diagnosis of HNL.4.The recurrence rate of HNL in children is relatively high,and attention should be paid to the possibility of recurrence in HNL children with rash and ANA positive. |
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