大剂量激素冲击治疗重症狼疮患者感染分析

Infection Analysis in Serve Lupus Patients Received High-Dose of Glucocorticoid Therapy

目的探讨大剂量激素冲击治疗重症系统系红斑狼疮(SLE)患者感染特点.方法回顾性分析145例SLE患者大剂量激素(甲基泼尼松龙200 mg以上×3)冲击治疗的患者(冲击组)和314例非大剂量激素冲击患者(非冲击组),对2组感染发生率、感染时间、感染部位、病原体种类、年龄、病程、免疫抑制剂和冲击前激素用量、受累脏器、白细胞、血红蛋白、白蛋白、免疫球蛋白、血沉、C反应蛋白进行分析.采用χ2检验进行统计学分析.结果 (1)大剂量激素冲击治疗组感染发生率显著高于非冲击组(分别为66.9%,32.2%,P<0.01),冲击组与非冲击组感染高峰均位于半年后,2组间差异无统计学意义(P>0.05).冲击组革兰氏阴性杆菌、真菌及巨细胞病毒检出率高于非冲击组(P<0.05),革兰氏阳性菌无统计学意义(P>0.05).主要病原菌是革兰阴性杆菌;(2)大剂量激素冲击治疗感染累及多系统,其中呼吸系统、泌尿系统和皮肤黏膜是SLE患者发生感染的主要受累系统,呼吸系统居首位.结论大剂量激素冲击治疗重症狼疮患者可显著增加感染风险,必须严格掌握病情,合理使用糖皮质激素.

Objective To explore the infection characteristics in SLE patients who received high-dose glucocortieoid therapy. Methods The data of 145 SLE patients who received high-dose glucocorticoid treatment and 314 SLE patients who did not receive high-dose glucocorticoid treatment were analyzed retrospectively. The infection rate, infection time, site of infection and pathogen species, age of patients, course of disease, consumption of immunosuppressive agent and hormones, involved organs, leukocytes, hemoglobin, albumin, immunoglobin, blood sedimentation and C reactive protein were compared between two groups. X2 test were used for statistical analysis. Results （1） The infection rate in high-dose glncocorticoid treatment group was significantly higher than that of non-shock group （respectively 66.9%, 32.2%, P〈0.01） .The rate of infection was high in Shock group and non -shock group after half a year, there were no significant difference between the two groups （P 〉0.05） . The infection rate of gram-negative bacilli, fungi and Cytomegalovirus in Shock group was higher than that of non-shock group （P〈0.05） , the difference in Gram positive bacteria infection had no statistical significance （P 〉 0.05） .The main pathogenic bacteria was Gr amnegative bacteria. （2） Multiple systems were involved in infection caused by high-dose glucocorticoid treatment, in which the respiratory system, urinary system and skin mucosa was the major involved system in infection of SLE patients, and respiratory system was the first. Conclusion High-dose glucocorticoids therapy for serve lupus patients can significantly increase the risk of infection, so we must strictly control condition and rationally use glucocorticoids.