系统性红斑狼疮合并败血症14例临床分析

Clinical sanalysis of 14 cases of systemic lupus erythematosus complicated with sepsis

目的分析系统性红斑狼疮(SLE)合并败血症的临床特点。方法选取2013年1月至2016年12月14例患者在海南省人民医院肾病风湿科住院确诊的SLE合并败血症,分析其临床资料和实验室检查结果。结果所有患者均表现球蛋白及C3降低,CRP升高;85.71%的患者表现出ESR升高及血白蛋白、淋巴细胞比例降低;78.57%的患者白细胞计数正常或降低,71.43%的患者中性粒细胞比例升高。14例患者中革兰阳性菌有9例,分别是溶血性葡萄球菌2例、金黄色葡萄球菌3例、表皮葡萄球菌2例、粪肠球菌1例、藤黄微球菌1例;革兰阴性菌有5例,分别为液化沙雷菌1例、醋酸不动杆菌1例、铜绿假单胞菌2例和产酸克雷伯菌1例。依据药敏结果,革兰阳性菌建议选择万古霉素、利奈唑胺等,革兰阴性菌建议头孢哌酮他唑巴坦、左氧氟沙星等。结论 SLE患者合并败血症病情凶险,当患者出现发热、畏寒等临床表现需高度警惕,依据药敏选择合适用药,注意平衡激素及免疫抑制剂关系,尽早控制病情。

Objective To investigate the clinical characteristics of systemic lupus erythematosus（SLE） complicated with sepsis. Methods Fourteen patients with SLE complicated sepsis who admitted to Department of Nephrology and Rheumatology in Hainan Provincial People＇s Hospital between 2013-2016 were reviewed in this study. The clinical data and laboratory test results of patients were analyzed. Results All patients showed globulin and C3 levels decreased, CRP increased. 85.71% of the patients showed ESR decreased, but serum albumin, lumphocyte proportion were decreased. 78.57% of the patients showed white blood cell（WBC） count with normal or reduced, and the proportion of neutrophils increased of 71.43% patients. 9 patients showed Gram-positive（G＋） bacteria in 14 cases（including Staphylococcus haemolyticus in 2 cases, Staphylococcus aureus in 3 cases, Staphylococcus epidermidis in 2 cases, Enterococcus faecalis in 1 case, Micrococcus luteus）. The G＋bacteria were hemolytic staphylococcus, staphylococcus aureus, epidermis staphylococcus, dung enterococcus, gambogic micrococcus. Gram negative bacteria showed 5 cases（including Serratia liquefaciens in 1 cases, Acinetobacter calcoaceticus in 1 case, Pseudomonas aeruginosa in 2 cases and Klebsiella oxytoca in 1 case）. According to the results of drug susceptibility, Gram positive bacteria were recommended to choose vancomycin, linezolid, and the Gram negative bacteria suggested that cefoperazone tazobactam and levofloxacin. Conclusion For patients with clinical manifestation such as fever, chills, the occurrence of SLE with sepsis shloud be alerted to. According to drug sensitivity, doctors should pay attention to balance the relationship between hormones and immunosuppressive agents and use drugs rationally, with early control of the disease.