类风湿性关节炎患者糖皮质激素用量及时间与肺部真菌感染发生的相关性研究

Correlation between glucocorticoid dosage and time and pulmonary fungal infection in patients with rheumatoid arthritis

目的开展类风湿性关节炎(RA)患者糖皮质激素用量及时间与肺部真菌感染发生的相关性研究,为临床糖皮质激素的运用提供依据。方法对2013年6月-2016年4月医院收治85例RA患者临床资料进行回顾性分析,记录患者肺部真菌感染情况,比较患者一般资料对感染率的影响,并采用ROC曲线分析糖皮质激素累积治疗时间、3周内日均糖皮质激素的用量对肺部真菌感染的影响。结果 85例RA患者中,发生肺部真菌感染患者32例,感染率37.65%;发生肺部真菌感染患者其糖皮质激素累积治疗时间以及糖皮质激素日均使用量均显著高于未感染患者,差异有统计学意义(P<0.05);糖皮质激素累积用药时间预测RA患者肺部真菌感染ROC曲线下面积为0.739(P<0.05);糖皮质激素日均用量预测RA患者肺部真菌感染ROC曲线下面积为0.857(P<0.05)。结论糖皮质激素的长期、大量运用可能导致类风湿性关节炎患者肺部真菌感染的风险增加,因此对于类风湿性关节炎患者的临床治疗,需要注意糖皮质激素的合理使用,避免患者发生肺部真菌感染。

OBJECTIVE To study the correlation between glucocorticoid dosage and time and pulmonary fungal infection in patients with rheumatoid arthritis（RA）,in order to provide the basis for the clinical application of glucocorticoid.METHODS The clinical data of 85 cases of RA patients from Jun.2013 to Apr.2016 in our hospital were analyzed retrospectively,pulmonary fungal infection of patients were recorded,the effects of general information on the infection rate were compared,and the effects of the cumulative glucocorticoid treatment time and daily glucocorticoid dosage on pulmonary fungal infection within 3 weeks were analyzed by the ROC curve.RESULTS In 85 cases of RA patients,32 cases of patients occurred pulmonary fungal infection,with the infection rate of 37.65%.The cumulative treatment time in patients with glucocorticoid and glucocorticoid daily usage in patients with pulmonary fungal infection were significantly higher than those in uninfected patients（P〈0.05）.The area under the ROC curve of predicting pulmonary fungal infection in patients with RA estimated by the cumulative glucocorticoid medication time was 0.739（P〈0.05）.The area under the ROC curve of predicting pulmonary fungal infection in patients with RA estimated by the average daily dose of glucocorticoid was 0.857（P〈0.05）.CONCLUSIONLong-term,intensive use of glucocorticoids may increase the risk of pulmonary fungal infection in patients with rheumatoid arthritis,so it needs to pay attention to the rational use of corticosteroids for the clinical treatment of patients with rheumatoid arthritis,to avoid the occurrence of pulmonary fungal infection in patients.