系统性红斑狼疮并发感染的流行病学研究

Epidemiology of Systemic Lupus Erythematosus Patients with Infection

目的 了解系统性红斑狼疮 (SL E)患者并发感染的流行病学特征。方法 前瞻性队列随访研究 SL E患者门诊、住院及其随访 ,观察、记录并统计分析 SL E患者的临床和实验室资料。结果 371例 SL E患者随访观察 1年 ,2 11例患者 (5 6 .8% )发生 341次感染 (医院感染 10 5次 ) ,其中 99例患者发作≥ 2次感染 ,79例患者 (37.4 % )发生≥ 2种病原体的混合感染 ;检出细菌感染 191次 (5 6 .0 % ) ,难治性条件致病菌明显增多 ,病毒感染 10 2次(2 9.9% ) ,真菌感染 4 2次 (12 .3% ) ,寄生虫类 6次 (1.8% ) ;呼吸道及皮肤粘膜是本组 SL E患者最常见感染部位 ;感染组较非感染组 ,平均住院日、SL EDAI、白细胞 /淋巴细胞减少、尿蛋白水平、补体 C3水平和 1年死亡率差异显著 ;单因素 L ogistic回归分析显示 SL EDAI>9、尿蛋白定量 >2 .0 g/ 2 4 h、MP冲击累积量 >1.5 g/疗程、CTX冲击量 >1.5 /月和平均激素日剂量 >0 .5 mg/ kg与 SL E患者并发感染有明显相关性 ;多因素 L ogistic逐步回归分析显示 ,只有尿蛋白定量 >2 .0 g/ 2 4 h、MP冲击累积量 >1.5 g/疗程、CTX冲击量 >1.5 /月和平均激素日剂量 >0 .5 mg/ kg是 SL E患者并发感染独立危险因素。结论 SL E患者并发感染的致病菌主要为细菌感染 。

OBJECTIVE To know the epidemiologic characteristics of systemic lupus erythematosus (SLE) patients with infection. METHODS A prospective cohort study was used. RESULTS Of 371 cases of SLE patients followed with one year, there were 211 cases (56.8%) and 341 episodes of infections, 99 cases with two episodes of infections, 79 cases with two or more kinds of pathogens overlap infections. Checked pathogens included bacteria (191 episodes, 56%), viruses (102 episodes, 29.9%), fungi (42, 12.3% ) and others (1.8%). There was significant difference in mean hospital time, SLEDAI, leukopenia/lymphopenia, 24h urine protein level, complement C3 level and one year death rate between infected SLE patients and control ones. Univariate Logistic regressions showed SLEDAI >9, urine protein >2.0 g/24 h, IV methylprednisolone (MP) cumulative dose (>1.5 g/3 d,) IV CTX cumulative dose >1.5 g/m and mean prednisone dose >30 mg/d, respectively correlated with infection, but multivariate regressions showed only urine protein >2.0 g/24 h, IV methylprednisolone (MP) cumulative dose >1.5 g/3d, IV CTX cumulative dose >1.5 g/m and mean prednisone dose >30 mg/d were independent risk factors for infection in patients with SLE. CONCLUSIONS Bacteria are main infective pathogens, and the lupus nephritis and immunosuppressive drugs therapy are major risk factors.