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系统性红斑狼疮合并感染的临床分析

Clinical analysis of systemic lupus erythematosus complicated with infection
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摘要 目的:分析系统性红斑狼疮(SLE)合并感染患者的临床特征。方法:回顾性分析2020年11月—2022年11月天津医科大学第二医院住院治疗的41例SLE合并感染患者的病例资料,包括一般情况、临床表现、实验室检查、感染类型、感染病原体、耐药情况及院内转归,根据感染的严重程度分为重症感染组(9例)与非重症感染组(32例)。结果:SLE合并感染患者41例,占同期住院SLE患者(328例)的12.5%。感染部位多为呼吸道(47.4%)及泌尿系(26.3%)。感染病原体分别为细菌39株(65.0%),真菌14株(23.3%),病毒6例(10.0%)以及肺炎支原体1例(1.7%)。细菌病原体中革兰阴性菌占比61.5%,其中大肠埃希菌多重耐药菌比例为90.9%,铜绿假单胞菌为25.0%,鲍曼不动杆菌为66.7%。重症感染组糖皮质激素使用剂量(χ^(2)=4.192,P=0.036)、中性粒细胞(Z=-1.764,P=0.003)、中性粒细胞/淋巴细胞比值(Z=3.244,P=0.001)、降钙素原(Z=2.266,P=0.023)、C反应蛋白(Z=2.539,P=0.011)、D-二聚体(Z=2.802,P=0.005)均高于非重症感染组。85.4%的患者经治疗后好转,14.6%死亡或放弃治疗。结论:SLE合并感染常发生在呼吸道和泌尿系,以细菌感染为主,感染严重程度与糖皮质激素使用剂量相关,中性粒细胞、中性粒细胞/淋巴细胞比值、降钙素原、C反应蛋白、D-二聚体可反映感染的严重程度。SLE感染病原体存在多重耐药现象。 Objective:To analyze the clinical characteristics of patients with systemic lupus erythematosus(SLE)complicated with infection.Methods:In this retrospective study,41 SLE patients complicated with infection were admitted to the Second Hospital of Tianjin Medical University from November 2020 to November 2022 were enrolled.The general information,clinical manifestations,laboratory examination,infection site,etiology findings and drug resistance and in-hospital outcomes were collected.According to the severity of the infection,the participants were divided into severe infection group(9 cases)and non-severe infection group(32 cases).Results:There were 41 patients with SLE co-infection,accounting for 12.5%of the 328 hospitalized SLE patients in the same period.The common sites of infection were respiratory tract(47.4%)and urinary tract(26.3%).The pathogens of infection included 39 bacteria(65.0%),14 fungi(23.3%),6 viruses(10.0%)and 1 mycoplasma pneumonia(1.7%).Gram negative bacteria accounted for 61.5%of bacterial pathogens,the proportion of multi-drug resistant bacteria in Escherichia coli was 90.9%,Pseudomonas aeruginosa was 25.0%,and Acinetobacter baumannii was 66.7%.The dose of glucocorticoids(χ^(2)=4.192,P=0.036),neutrophils(Z=-1.764,P=0.003),neutrophil/lymphocyte ratio(Z=3.244,P=0.001),procalcitonin(Z=2.266,P=0.023),C-reactive protein(Z=2.539,P=0.011)and D-dimer(Z=2.802,P=0.005)in the severe infection group were higher than those in the non-severe infection group.85.4%of the patients were discharged after treatment,and 14.6%died or gave up treatment.Conclusion:SLE co-infection often occurs in respiratory tract and urinary tract.Bacterial infections are most common.The severity of infection was positively correlated with the dose of glucocorticoid.Neutrophils,neutrophil/lymphocyte ratio,procalcitonin,C-reactive protein and D-dimer can reflect the severity of infection.Multiple drug resistance exists in pathogens of SLE infection.
作者 崔晓慧 曹源 孟晓楠 刘雅雯 梁歌宏 王聪 杨惠芬 王悦 CUI Xiaohui;CAO Yuan;MENG Xiaonan;LIU Yawen;LIANG Gehong;WANG Cong;YANG Huifen;WANG Yue(Department of Rheumatology and Immunology,The Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Rheumatology and Immunology,People′s Hospital of Zhengzhou,Zhengzhou 450000,China)
出处 《天津医科大学学报》 2024年第3期260-266,共7页 Journal of Tianjin Medical University
关键词 系统性红斑狼疮 感染 临床特征 耐药性 systemic lupus erythematosus infection clinical characteristic drug resistance
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