系统性红斑狼疮合并深部真菌感染102例临床分析

Clinical analysis of deep fungal infections in 102 patients with systemic lupus erythematosus

目的:探讨SLE合并深部真菌感染的病原学特征、易感因素、治疗和转归。方法:对住院治疗的102例SLE合并深部真菌感染患者的临床资料进行回顾性分析。结果:102例真菌感染患者占同期住院1350例SLE患者的7.6%,其中39例(38.2%)为医院内感染。感染部位最常见为肺(37.5%),其次为胃肠道和泌尿生殖道。20例发生2个或2个以上部位的感染。病原菌以白假丝酵母菌为主(40.6%),其次为热带假丝酵母菌、光滑假丝酵母菌和新生隐球菌。易感因素前3位为长期接受肾上腺皮质激素(激素)治疗者、联合应用免疫抑制剂者、低蛋白血症者。根据病原菌选择抗真菌药物,氟康唑、两性霉素B、伊曲康唑和伏立康唑为主要治疗药物。治愈48例,好转28例,未愈5例,死亡21例,病死率为20.6%。结论:SLE患者合并深部真菌感染率高,且病死率高。多部位感染常见,以肺部为感染的高发部位,病原菌以白假丝酵母菌为主,长期接受激素、免疫抑制剂、广谱抗生素治疗和侵入性操作等是其常见易感因素。建议在治疗原发病的同时做好真菌感染的防治工作,有助于改善SLE的预后。

Objective： To discuss the etiology, risk factors, antifungal therapy and outcomes of deep fungal infections in patients with SLE. Methods： Retrospective analysis was performed in 102 hospitalized SLE patients with deep fungal infections. Resuits： Among 1 350 SLE patients, 102 cases had deep fungal infections with an incidence of 7.6 % , of which 39 cases （38.2%） were nosocomial infections. Lung was the most common infection site （37.5%）, followed by gastrointestinal tract and urogenital tract. Twenty patients had two or more loci of infection. The most common pathogenic microorganism was Candida albicans （40. 6% ）, followed by Candida tropical, Candida smooth and Cryptococcus neoformans. The major risk factors were long-term use of corticosteroids, immunosuppressants and hypoproteinemia. The selection of antifungal drugs was based on pathogen. Fluconazole, amphotericin B, itraconazole and voriconazole were the main drugs. Of all the cases, 48 were cured, 28 improved, 5 were not effective and 21 died, with a mortality of 20. 6%. Conclusion： SLE patients are prone to complication of deep fungal infections with high mortality. The most common infection site is the lung and the most common pathogenic microorganism is Candida albicans. The common risk factors are invasive operation, long-term use of corticosteroids, immunosuppressants and broad-spectrum antibiotics. Clinicians should pay more attention to SLE for deep fungal infections. Early diagnosis and rational treatment could improve the prognosis.