狼疮性肾炎患者并发感染的临床分析

Infection of patients with lupus nephritis

目的:分析狼疮性肾炎(LN)治疗过程中感染的临床特点和流行病学特征。方法:回顾性分析699例Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅳ+Ⅴ及Ⅴ+Ⅲ型LN患者在治疗过程中感染的发生率、发生时期、部位及病原体种类特点。结果:(1)699例LN患者,其中男92例,女607例,平均年龄28.4±11.1岁,平均随访46月。191例(27.3%)患者共发生225例次感染,其中30例2次感染,2例3次感染。(2)225例次感染中,124例次(55.1%)发生在诱导期,发生时间2.6±1.6月;101例次(44.9%)发生在维持期,发生时间24.3±16.6月。(3)感染部位以皮肤软组织、肺、泌尿系统为主(89.3%);感染病原体以细菌最常见(54.2%),其次为病毒(39.6%)和深部真菌(4%)感染。(4)诱导期感染部位主要为皮肤软组织(50.8%)、肺(32.3%)和泌尿系统(11.3%);维持期感染部位主要为泌尿系统(35.6%)、皮肤软组织(30.7%)和肺(16.8%)。(5)诱导期病毒(50.8%vs25.7%,P<0.01)和真菌(6.5%vs1%,P<0.01)感染比例高于维持期,而细菌感染比例低于维持期(42.7%vs68.3%,P<0.01)。结论:LN并发感染的总体发生率为27.3%,感染最常发生于诱导治疗3月内,诱导期与维持期感染部位及病原体种类均存在差异。

Objective： To investigate the clinical and epidemiologic features of infection in patients with lupus nephritis （LN）. Methodology： Six hundred and ninety-nine LN patients were enrolled in this study. They were 607 female,92 male with a mean age of 28.4 ± 11.1 years old. All of them were performed renal biopsy, and their histological patterns were Class Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅳ±Ⅴ or Ⅴ±Ⅲ type. The infection incidence, infectious phase, sites and infective pathogens in different phases were analyzed retrospectively. Results： （ 1 ） There were 191 cases （27.3%） of 699 LN patients with infection complication, the total duration of follow-up was 46 months. 191 patients had 225 infection episodes, 30 eases with two episodes of infection, and 2 cases with three episodes of infection. （2）Of 225 infection episodes, 124 （55.1%）episodes occurred in the phase of induction therapy after a follow-up period of （2. 6 ± 1.6） months. 101 （44. 9% ）episodes happened in the phase of maintenance therapy, and time of occurrence were （24. 3 ± 16. 6）months. （3） The most common affected sites were skin,lung and urinary tract system（ 89. 3% ）. The most common pathogens were bacteria （54. 2% ）, followed by virus （ 39.6% ） and deep fungus （ 4% ） , respectively. （ 4 ） In the phase of induction therapy,the most common affected sites were skin （50.8%）, lung （32.3%） and urinary tract system （11.3%）, respectively. However,in the maintenance phase, the infection sites were urinary system（35.6% ） ,skin（30. 7% ） and lung （ 16. 8% ）, respectively. （5）The induction and maintenance phase, the most pathogens were bacteria（42. 7 % vs 68.3 %, P〈0. 01） ,virus（50. 8% vs 25. 7% ,P〈0.01） ,fungi（6. 5% vs 1% ,P〈0. 01）. Conclusion：The incidence of infection in patients with LN was 27.3% , and usually occurred within the 3 months. There were significant differences in affected sites and pathogens during the phase of induction and maintenance therapy.