近年系统性红斑狼疮患者合并感染的主要临床特点及其防治要点初探

Clinical features of patients suffering systemic lupus erythematosus complicated with infection and discussion on the main points of prevention and cure

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者合并感染的临床特点和治疗问题。方法回顾性分析2017年1月—2018年1月入住蚌埠医学院第一附属医院风湿免疫科的SLE患者328例,分析其中合并感染的患者的临床特点、高危因素和病情活动度对治疗的影响。结果 SLE患者感染发生率58.23%(191例),其中男12例,女179例,平均(36.74±12.83)岁,平均病程(3.88±4.87)年,狼疮性肾病(53.4%),狼疮合并血液系统损害(35.6%),狼疮合并皮肤损害(17.2%)患者感染发生率较高。191例患者研究期间共出现217次感染,主要感染灶依次为:呼吸系统94例(43.3%),泌尿系统67例(30.9%),皮肤软组织22例(10.14%)。感染组与非感染组相比SLEDAI评分(10.04±5.23 vs 8.03±3.82,P<0.001),ANA定量(275.04±153.41 vs 221.62±115.08,P=0.02)升高,住院天数延长(17.32±6.07 vs15.20±5.14,P=0.001)。HGB(100.72±25.09 vs 107.99±23.36,P=0.009),RBC(3.60±0.93 vs 3.86±0.82,P=0.01),白蛋白(33.39±7.45 vs 35.87±7.00,P=0.003),25(OH) D3(13.94±4.53 vs 19.14±6.53,P=0.04)降低,其他指标比较无统计学差异。SLEDAI评分(B=0.162,P=0.004,95%置信区间1.054-1.311)是SLE患者合并感染的高危因素。将合并感染的SLE患者依据病情活动度分为活动组与稳定组,活动组SLEDAI(10.92±4.85 vs 2.90±1.13,P<0.001),ANA定量(275.04±153.41 vs 221.62±115.08,P=0.02)较稳定组升高,尿蛋白定量(1.64±2.26 vs 0.56±0.9,P=0.005),RBC(3.60±0.93 vs 3.86±0.82,P=0.01),D二聚体(1.95±2.45 vs 0.62±0.48,P<0.001),25(OH) D3(12.94±4.53 vs 16.21±5.28,P=0.03)较稳定组降低。两组患者的住院时间,使用抗生素时间,使用糖皮质激素的最高剂量及其他各项临床指标比较均无统计学差异; SLE患者感染发生率各季度不同(χ~2=8.853,P=0.031),其中第一季度(1~3月)发生率最高。结论感染是SLE常见并发症,病情活动度高、自身基础状态差及季节差异均易导致感染,其中积极控制原发病活动是首要任务,对于诊治合并的感染也有重要意义。

Objective To explore the clinical features and treatment of patients with systemic lupus erythematosus( SLE) complicated with infection. Methods A retrospective analysis was made of 328 patients with SLE hospitalized in the first affiliated hospital of Bengbu medical college from January 2017 to January 2018.The clinical characteristics and high risk factors of the SLE patients complicated with infection,the influence of degree of disease activity on the treatment effect were analyzed. Results There were 191 cases( 58.23%) of SLE patients combined with infection,which including 12 male and 179 female,the average age was( 36.74± 12.83)years,the average course of disease was( 3.88±4.87) years. The number of system damage: 102 cases of urinary system( 53.4%),blood system 68 cases( 35. 6%) and skin involvement. Among the 217 infections of the 191 patients,there were 94 cases of respiratory infection( 43.3%),67 cases of urinary tract infection( 30.9%),22 cases of skin soft tissue infection( 10.14%). Compared with non-infection group,SLEDAI( 10.04±5.23 vs 8.03±3.82,P< 0. 001) and ANA quantitative( 275. 04 ± 153. 41 vs 221. 62 ± 10. 14%,P = 0. 02) of infection group increased,time of hospitalization prolonged( 17.32±6.07 vs 15.20±5.14,P = 0.001). The concentration of HGB( 100.72±25.09 vs 107.99±23.36,P= 0.009),RBC( 3.60±0.93 vs 3.86±0.82,P= 0.01),albumin( 33.39±7.45 vs 35.87± 7,P = 0. 003),25( OH)D3( 13. 94 ± 4. 53 vs 19. 14 ± 6. 53,P = 0. 04) decreased,and there was no statistical difference in the other indexes. SLEDAI score was the high risk factors for infection. Patients with SLE infection were divided into active group and stable group according to disease activity. SLEDAI( 10.92±4.85 vs 2.90±1.13,P<0.001),ANA( 275.04±153.41 vs 221.62±115.08,P = 0.02) of active group were increased. While urinary protein quantitative( 1.64±2.26 vs 0.56± 0.9,P = 0.005),RBC( 3.60± 0.93 vs 3.86± 0.82,P = 0.01).The D-dimer( 1.95±2.45 vs 0.62±0.48,P<0.001) and 25( OH) D3( 12.94± 4.53 vs 16.21± 5.28,P = 0.03)were decreased. There was no statistical difference in the time of hospitalization,antibiotic use,the maximum amount of hormone and the other clinical indexes. The probability of infection in SLE patients was different in the four quarters( χ^2= 8. 853,P = 0. 031),the highest incidence was in the first quarter( January-March).Conclusions Infection is a common complication of SLE. High activity,poor basic state of the disease and environmental impact can lead to the occurrence of infection. It is necessary to actively control the degree of primary activity.