112例次狼疮性肾炎尿路感染临床分析

Clinical Analysis on 112 Episodes of Urinary Tract Infection in Patients with Lupus Nephritis.

目的分析112例次狼疮性肾炎尿路感染的临床特征及其危险因素。方法从患者性别、年龄、尿路感染症状,系统性红斑狼疮疾病活动指数(SLEDAI),白细胞和血小板水平,自身抗体,补体,泌尿系统彩色多普勒超声检查结果,尿培养与药敏结果,激素和细胞毒药物的使用等方面对我科近5年来收治的112例次狼疮性肾炎尿路感染进行回顾性调查分析。结果狼疮性肾炎尿路感染占我科同期狼疮性肾炎的比例为36.5%,且以复杂性尿路感染为主(58%),有症状的尿路感染为62%,无症状性尿路感染38%。平均SLEDAI为15.7(SD3.05),与尿路感染的发生显著相关(P<0.01),ANA效价、血白细胞和血小板减少也与尿路感染的发生有显著相关性(P<0.05),肾盂积水、激素和(或)细胞素药物的使用与尿路感染的发生密切相关(P<0.01)。尿培养结果示大肠杆菌为主要致病菌(87.5%),真菌和混合感染比例较高(分别为14.4%和23.9%),针对大肠杆菌敏感的药物主要为三代头孢菌素(81.6%)和庆大霉素(83.9%)。结论 LN患者是UTI的高危人群,常为复杂性尿路感染。狼疮活动、ANA高效价、血自细胞和血小板减少、肾盂积水、激素和(或)细胞素药物的使用是其发生的危险因素;大肠杆菌为主要致病菌,三代头孢和(或)庆大霉素可作为LN患者UTI的经验性用药。

Objective To analyze the clinical feature and its risk factors on 112 episodes of urinary tract infection （UTI） in patients with lupus nephritis. Methods 112 episodes of UTI in patients with lupus nephritis in our department during the past 5 years were reviewed retrospectively. Epidemiological data and information on urinary symptoms, disease activity （SLEDAI） , leukocyte and platelet data were collected. Autoantibodies, complement levels, urine culture, and antibiogram were determined. Urological studies were carried out. The use of corticosteroids and （or） immunodepressive were also investigated. Results The prevalence of UTI in lupus nephritis patients was 36.5% , and complexity infection（58%） was the main UTI . Symptomatic UTI was 62% , and symptomless UTI was 38%. The mean SLEDAI score was 15.7 （ SD3.05 ） , which influenced the onset of UTI （ P 〈 0.01 ）, regardless of other variables. UTI risk factors in lupus nephritis patients were antinuclear antibodies （ANA） 〉 1/100 IU/ml, leueopenia and thromboeytopenia （P 〈 0.05 ） , Nephrydrosis, the use of eortieosteroids and （or） immunodepressive （P 〈 0.01 ） had a bearing on the onset of UTI. The uropathogen isolated most frequently was E coli （87.5%）. Mycetes and combined infection were in a high proportion（ 14.4% and 23.9% , respectively）. E coli was susceptible to third generation cephalosporin and/or gentamicin. Conclusion Lupus patients are likely to have UTI, usually manifesting in the complexity infection. They are basically caused by E coli, and favoured by lupus activity, ANA, thrombopenia, leucopenia, nephrydrosis, corticosteroids and （or） immunodepressive treatments, we suggest an empirical treatment of UT） in patients with lupus nephritis by third generation cefalosporin and/or gentamicin.