红斑狼疮患者深部真菌感染危险因素及预防对策

Causes of deep fungal infections in patients with systemic lupus erythematosus and prevention countermeasures

目的探讨引起系统性红斑狼疮(SLE)患者深部真菌感染的危险因素及相应对策,为临床治疗提供参考。方法对医院2009年12月-2012年11月收治的462例SLE患者合并深部真菌感染情况进行回顾性调查分析,并针对感染危险因素提出预防对策。结果 462例SLE患者合并深部真菌感染100例,感染率为21.6%,共分离出真菌126株,排名前5位真菌依次为白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌、新型隐球酵母菌、近平滑假丝酵母菌,分别占39.7%、13.5%、12.7%、9.5%、8.7%;感染发生部位主要为肺部、消化道及泌尿道,分别为38.89%、19.84%、18.25%;长期使用激素类药物、免疫抑制剂、侵入性操作及滥用抗菌药物是SLE患者发生深部真菌感染的危险因素。结论 SLE患者机体免疫机能下降,应避免长期使用激素类药物及免疫抑制剂,严格无菌操作,避免滥用抗菌药物,以预防深部真菌感染的发生。

OBJECTIVE To study the risk factors of deep fungal infections in the patients with systemic lupus erythematosus（SLE）and put forward the corresponding countermeasures so as to guide the clinical treatment.METHODS A total of 462SLE patients,who were treated in the hospital from Dec 2009to Nov 2012,were enrolled in the study,the incidence of deep fungal infections was retrospectively analyzed,then the prevention countermeasures were put forward according to the risk factors.RESULTS Of totally 462cases of SLE patients,the deep fungal infections occurred in 100patients with the incidence rate of 21.6%.There were 126strains of fungi were isolated,among which the top five species were in turn as Candida albicans,Candida glabrata,Candida tropicalis,Cryptococcus neoformans,and Candida parapsilosis,accounting for 39.7%,13.5%,12.7%,9.5%,and 8.7%,respectively.The lung,gastrointestinal tract,and urinary tract were the predominant infection sites,accounting for 38.89%,19.84%,and 18.25%,respectively.The long-term use of hormone drugs or immune inhibitors,invasive operation,and abuse of antibiotics were the risk factors of the deep fungal infections in the SLE patients.CONCLUSIONThe body＇s immune function of the SLE patients declines,it is necessary to avoid the long-term use of hormone drugs or immune inhibitors,strictly implement the aseptic operation,and reasonably use antibiotics so as to prevent the deep fungal infections.