亚急性坏死性淋巴结炎患儿的临床特征及疾病复发的危险因素分析

胡湘萍

文章摘要

亚急性坏死性淋巴结炎患儿的临床特征及疾病复发的危险因素分析

投稿时间：2022-09-01 修订日期：2022-12-08

DOI：

中文关键词: 儿童亚急性坏死性淋巴结炎临床特征疾病复发危险因素

英文关键词: Histiocytic necrotizing lymphadenitis in children Clinical characteristics Disease recurrence Risk factors

基金项目:无

作者	单位	邮编
胡湘萍^*	河南省濮阳市人民医院	457000

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中文摘要:

目的探究亚急性坏死性淋巴结炎(HNL)患儿的临床特征,并对其疾病复发的危险因素进行分析。方法以2018年5月~2021年2月59例HNL患儿为研究对象,分析其临床症状。所有患儿均随访1年,根据复发情况将其分为复发组及未复发组,分析影响HNL复发的危险因素,以此建立预测模型,并分析该模型对HNL复发的预测价值。结果 59例HNL患儿中男性比例高于女性(61.02% vs38.98%),年龄≥7岁患儿的比例高于<3岁、3~<7岁患儿(79.66% vs5.08%、15.25%,P<0.05)；不同季节HNL发病率对比无明显差异(P>0.05)；HNL患儿的首发症状中发热、淋巴结肿大的检出率高于呼吸系统症状、消化系统症状、皮疹、头痛(52.54%、61.02%vs16.95%、30.51%、3.39%、1.69%,P<0.05)；不同病理类型患儿白细胞计数及血红蛋白对比无明显差异(P>0.05),三组血沉对比有显著性差异,增生型、坏死型HNL患儿的血沉低于黄色瘤样型HNL患儿[(45.19±6.21)mm/h、(46.37±5.39)mm/h vs(52.02±5.67)mm/h,P<0.05]；本研究纳入的HNL患儿复发率为22.03%(13/59),复发组中合并其他自身免疫性疾病、EB病毒IgG阳性的患儿比例高于未复发组,白细胞计数少于未复发组(P<0.05)；合并其他自身免疫性疾病、EB病毒IgG阳性及白细胞计数<3.5*109^/L是影响HNL复发的危险因素(P<0.05)；根据多元logistic回归分析结果,得出HNL复发的风险预测模型,P=1/[1+e(0.962+0.538X^{合并其他自身免疫性疾病}+0.824X^EB病毒IgG阳性-0.775^X白细胞计数)^]。经Hosmer-Lemeshow检验分析显示说明该预测模型与观测值拟合度较好(χ2⁼4.539,P=0.806)；ROC曲线显示,该预测模型预测HNL复发的AUC为0.863,SE值0.060,95%CI：0.746~0.980,敏感度为84.62%,特异度为82.61%。结论发热及淋巴结肿大是HNL患儿的主要症状,患儿血沉水平与病理类型有关,合并其他自身免疫性疾病、EB病毒IgG阳性及白细胞计数降低是影响患儿复发的危险因素。

英文摘要:

Objective To explore the clinical characteristics of children with histiocytic necrotizing lymphadenitis (HNL) and analyze the risk factors of disease recurrence. Methods 59 children with HNL between May 2018 and February 2021 were selected as the research subjects, and their clinical symptoms were analyzed. All the children were followed up for 1 year, and they were divided into recurrence group and non-recurrence group according to the recurrence situation. The risk factors affecting the recurrence of HNL were analyzed to establish a predictive model, and the predictive value of the model on the recurrence of HNL was analyzed. Results Among the 59 children with HNL, the proportion of males was higher than that of females (61.02% vs 38.98%), and the proportion of children with age≥7 years old was higher than that of children with age<3 years old and children with age of 3 to 7 years old (79.66% vs 5.08%, 79.66% vs 15.25%, P<0.05). There was no significant difference in the incidence rate of HNL in different seasons (P>0.05). In terms of the first symptoms of children with HNL, the detection rate of fever (52.54%) or lymphadenopathy (61.02%) was higher than that of respiratory symptom (16.95%), gastrointestinal symptom (30.51%), rash (3.39% and headache (1.69%) (P<0.05). There were no significant differences in white blood cell count and hemoglobin among children with different pathological types (P>0.05), but there was a significant difference in the erythrocyte sedimentation rate among the three types of children. The erythrocyte sedimentation rate of children with proliferative HNL [(45.19±6.21) mm/h] or necrotic HNL [(46.37±5.39) mm/h] was lower than that of children with xanthomatous HNL [(52.02±5.67) mm/h] (P<0.05). The recurrence rate of children with HNL included in this study was 22.03% (13/59). The proportions of children with other autoimmune diseases and EB virus positive IgG in recurrence group were higher than those in non-recurrence group, while the white blood cell count was lower than that in non-recurrence group (P<0.05). Presence of other autoimmune diseases, EB virus positive IgG and white blood cell count<3.5*10⁹/L were risk factors affecting HNL recurrence (P<0.05). According to multivariate logistic regression analysis, the risk prediction model of HNL recurrence was shown as P=1/[1+e (0.962+0.538X^{presence of other autoimmune diseases}+0.824X^{EB virus positive IgG}-0.775X^{white blood cell count}⁾]. Hosmer-Lemeshow test analysis showed that the prediction model had a good fit with the observed value(χ2^=4.539,P=0.806). ROC curve revealed that the AUC, SE value, 95% CI, sensitivity and specificity of the prediction model for HNL recurrence were 0.863, 0.060, 0.746~0.980, 84.62% and 82.61%. Conclusion Fever and lymphadenopathy are the main symptoms of children with HNL. The erythrocyte sedimentation rate in children is related to the pathological types. Presence of other autoimmune diseases, EB virus positive IgG and low white blood cell count are the risk factors for recurrence in children.

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