[儿童期外周淋巴结病——诊断评估建议]

Benesch M, Kerbl R, Wirnsberger A, Stünzner D, Mangge H, Schenkeli R, Deutsch J

Universitätsklinik für Kinder- und Jugendheilkunde, Karl-Franzens-Universität Graz.

Klin Padiatr. 2000 Sep-Oct;212(5):277-82. doi: 10.1055/s-2000-9688.

BACKGROUND

Enlargement of peripheral lymph nodes most commonly caused by a local inflammatory process is frequently seen in childhood. The aim of the present study was to analyze the most common causes of peripheral lymphadenopathy and to develop a simple algorithm for the primary diagnostic evaluation of peripheral lymph node enlargement in this age group.

PATIENTS

Between April and September 1999 87 unselected children (median age: 5 1/2 years) with peripheral lymphadenopathy were referred to the Department of Pediatrics, University of Graz, for further investigation.

RESULTS

EBV infection was diagnosed in 20 (23.0%) children. 19 (21.8%) patients had acute bacterial lymphadenitis. In 21 (24.1%) patients lymph node enlargement was classified as "post/parainfectious (viral)". Four patients each had toxoplasmosis and cat scratch disease. In 11 (12.6%) patients neither physical nor laboratory examinations revealed pathologic results. Among the remaining 8 children sarcoidosis and Hodgkin disease was diagnosed in one patient each. Small, soft, mobile, nontender, cervical, axillary or inguinal lymph nodes do not require further investigations. In case of enlarged, tender lymph nodes with overlying skin erythema and fever diagnostic evaluation should include complete blood count, erythrocyte sedimentation rate and/or c-reactive protein level, supplemented by appropriate antibody testing (EBV, CMV, Toxoplasma gondii, Bartonella henselae). Firm, enlarged, painless lymph nodes which are matted together and fixed to the skin or underlying tissues necessitate a more detailed diagnostic evaluation in order to exclude malignant or granulomatous diseases.

CONCLUSIONS

Our study demonstrated that primary diagnostic evaluation of childhood peripheral lymphadenopathy is mainly based on clinical grounds. In most cases a small number of additionally performed laboratory tests allow to correctly identify the cause of the peripheral lymph node enlargement.

背景

外周淋巴结肿大最常见的原因是局部炎症过程，在儿童期很常见。本研究的目的是分析外周淋巴结病的最常见原因，并为该年龄组外周淋巴结肿大的初步诊断评估制定一个简单的算法。

患者

1999年4月至9月期间，87名未经挑选的患有外周淋巴结肿大的儿童（中位年龄：5.5岁）被转诊至格拉茨大学儿科进行进一步检查。

结果

20名（23.0%）儿童被诊断为EBV感染。19名（21.8%）患者患有急性细菌性淋巴结炎。21名（24.1%）患者的淋巴结肿大被归类为“感染后/感染旁（病毒）性”。各有4名患者患有弓形虫病和猫抓病。11名（12.6%）患者的体格检查和实验室检查均未发现病理结果。在其余8名儿童中，分别有1名患者被诊断为结节病和霍奇金病。小的、柔软的、可移动的、无压痛的颈部、腋窝或腹股沟淋巴结无需进一步检查。如果淋巴结肿大、有压痛、伴有皮肤红斑和发热，诊断评估应包括全血细胞计数、红细胞沉降率和/或C反应蛋白水平，并辅以适当的抗体检测（EBV、CMV、弓形虫、汉赛巴尔通体）。坚硬、肿大、无痛的淋巴结相互融合并固定于皮肤或深部组织，需要进行更详细的诊断评估以排除恶性或肉芽肿性疾病。