摘要
目的探讨SLE合并感染的临床特点,分析导致感染的危险因素。方法收集173例次SLE患者的临床资料,根据是否合并感染分为感染组(87例次)和无感染组(86例次)。归纳总结87例次SLE合并感染的SLE患者发生感染的部位、所感染病原体的种类、治疗方案、时长及结局,比较使用不同种类免疫抑制剂的SLE患者感染发生率。采用Logistic回归分析SLE患者发生感染的危险因素。结果 SLE患者合并感染的发生率为50.7%,53例次(60.9%)的感染发生在病程1年内的初发SLE患者中。87例次SLE合并感染患者的感染部位以肺部、上呼吸道和尿路为主,病原体以细菌、真菌居多,使用环磷酰胺者的感染发生率明显高于使用吗替麦考酚酯者(P<0.01)。84例次行抗感染治疗,58.6%患者的抗感染治疗时间在2周以内,经抗感染治疗后,80例次(92.0%)的感染得以控制,2例(2.3%)死亡,2例转院,3例患者放弃治疗。单因素Logistic回归显示,住院时间过长、SLE疾病活动指数高、使用较大剂量激素及免疫抑制剂治疗、补体(C)3、C4降低、发热、ESR升高、CRP升高、血白细胞计数异常以及血清白蛋白过低是SLE患者发生感染的危险因素(P均<0.05)。多因素Logistic回归显示,白细胞计数异常、CRP升高、C4降低以及住院时间过长是SLE患者出现感染的独立危险因素(P均<0.05)。结论对于SLE患者尤其是病程1年以内的初发SLE患者应高度警惕感染的可能,白细胞计数异常、CRP升高、C4降低及住院时间过长均会增加感染的风险,应密切留意患者的各项实验室指标,对有感染症状者做到早发现、早治疗,以改善预后。
Objective To investigate the clinical features of systemic lupus erythematosus （SLE） patients complicated with infection and analyze the risk factors of infection.Methods Clinical data from 173 SLE patients were collected and all participants were divided into the infection （n =87）and non-infection groups （n =86）.The site of infection,type of pathogen,treatment method and time,and clinical outcome in 87 SLE patients complicated with infection were retrospectively reviewed.The incidence of infection among pa-tients using different types of immunosuppressant agents was statistically compared.The risk factors of infection in SLE patients were assessed by logistic regression analysis.Results The incidence rate of SLE complicated with infection was 50.7%.Approximately 60.9% （n =53）of these patients were infected within 1-year onset of SLE.The most common infection sites were lung,upper respiratory tract and urinary tract.The most com-mon pathogens included bacteria and fungi.The incidence rate of infection in patients using cyclophosphamide was significantly higher compared with that in those receiving mycophenolate mofetil （P 〈0.01）.Among 84 patients receiving anti-infectious therapy,58.6% of them were treated for 〈2 weeks.Following anti-infec-tious treatment,80 cases （92.0%）were effectively controlled,two died （2.3%）,two were transferred to an-other hospital and three abandoned the therapy.Univariate logistic regression analysis demonstrated that long length of hospital stay,high SLE disease activity index （SLEDAI）,use of a large dose of steroid and immuno-suppressant agents,decreased serum level of complement 3 and 4 （C3 and C4）,fever,elevated levels of e-rythrocyte sedimentation rate （ESR ）and C reactive protein （CRP）,abnormal white blood cell count and ex-cessively low level of albumin were the risk factors of SLE complicated with infection （all P 〈0.05）.Multiva-riate logistic regression analysis revealed that abnormal white blood cell count,elevated level of
出处
《新医学》
2015年第11期743-747,共5页
Journal of New Medicine
基金
中华医学会临床医学科研专项--风湿病学发展与研究资金项目(12040700370)
关键词
系统性红斑狼疮
感染
感染部位
病原体
危险因素
Systemic lupus erythematosus
Infection
Infection site
Pathogen
Risk factor
