系统性红斑狼疮487例住院患者发热的病因及相关分析

Causes of fever in systemic lupus erythematosus： a retrospective study of 487 hospitalized patients

目的探讨系统性红斑狼疮（SLE）发热的病因，活动性发热与感染性发热的临床特点以及对糖皮质激素治疗的反应。方法回顾性分析2002年1月至2007年5月SLE伴发热的住院患者的临床表现、实验室检查和治疗情况等。结果共有487例SLE住院患者伴发热，其病因为：感染265例、疾病活动206例、活动合并感染8例、肿瘤4例，其他4例。常见的感染部位主要为：呼吸道61．3％，皮肤黏膜10．9％，中枢神经系统9．1％。常见的病原体主要为：细菌77．4％，真菌13．5％，病毒7．8％。大部分SLE活动性发热患者（81．0％）在给予相当于泼尼松剂量≤100mg/d治疗1．5d后体温可恢复正常。通过对照研究，补体C3、C4、CH50下降，贫血，淋巴细胞增多，免疫球蛋白水平升高，抗双链DNA（dsDNA）抗体、抗核抗体（ANA）滴度升高，SLE疾病活动指数（SLEDAI）积分高与活动性发热相关；原发病病程长，发病年龄大，血清C反应蛋白（CRP）升高，白细胞与中性粒细胞增多，整个病程中糖皮质激素累积剂量高，以及发热前6个月曾接受免疫抑制剂治疗与感染性发热相关。结论感染和疾病活动是导致SLE住院患者发热的主要原因。两者的临床特点以及对糖皮质激素治疗的反应不尽相同，慎重并正确地应用糖皮质激素与免疫抑制剂治疗是改善SLE发热患者预后的关键。

Objective To investigate the causes of fever in systemic lupus erythematosus （SLE） patients and identify the characteristics of the fever caused by SLE fever infection after steroid therapy. Methods From January 2002 to May 2007, 487 SLE hospitalized patients with fever were admitted and their data were retrospectively studied. The clinical manifestations and medications were followed up. A case control design was carried out to identify the differences between fever caused by lupus and infection. Results Among all the 487 patients, 265 had infection, 206 had fever that was caused by SLE per se, fever caused by both lupus and concurrent infection was confirmed in 8 patients, malignancy and miscellaneous were the causes of fever in 4 respectively. The most common sites of infection were respiratory tract （61.3%）, skin and mucosa （10.9%） and central nervous system （9.1%）. The main microorganisms isolated were bacteria （77.4%）, fungi （13.5%） and virus （7.8%）. Prednisone ≤ 100 mg/d could suppress fever caused by lupus in 81.0% patients, usually within 1 to 5 days. In the case control study, lower C3, C4 and CH50, anemia, lymphocytosis, higher immunoglobulin levels, elevated anti-dsDNA antibodies, elevated anti-nuclear antibodies and higher SLEDAI score were associated with SLE fever. Long SLE duration, old age, elevated CRP levels, leukocytosis, neutrophilia, high accumulated doses of prednisone and ever use of immunosuppressive medications were factors associated with infection. Conclusion The fever of in-patient SLE patients is mainly caused by infections and disease flare. Moderate dose of steroid therapy is effective to control the fever caused by lupus flare. The fever caused by SLE has different clinical features and laboratory results when compared to that caused by infection although both responses to steroid therapy.