系统性红斑狼疮伴真菌感染的病原学特点、耐药性及危险因素分析

Pathogenic characteristics,drug resistance and risk factors of systemic lupus erythematosus with fungal infection

目的探讨系统性红斑狼疮伴真菌感染的病原学特点、耐药性,并分析其危险因素。方法回顾性分析该院78例系统性红斑狼疮伴真菌感染患者的临床资料,行病原菌与耐药性试验,并针对影响系统性红斑狼疮伴真菌感染的相关因素行多因素Logistic回归分析。结果 554例系统性红斑狼疮患者有78例发生真菌感染,占14.08%;感染部位中,呼吸道、泌尿生殖道感染发生率较高,分别占29.49%、25.64%。78例患者中真菌培养结果共发现102株真菌,其中白色假丝酵母菌与新生隐球菌分别占总数的52.94%、31.37%。通过多因素Logistic回归分析显示,住院时间>4周、24h尿蛋白水平≥3.5g、器官损伤累及数≥3个、抗菌药物应用时间≥2周及白细胞计数≥3×109/L、CD4+≤200个/微升、补体C3<0.8mg/L均是影响其感染的独立危险因素。结论影响系统性红斑狼疮伴真菌感染因素较多,临床应根据其感染部位及感染真菌类型,选择不同的药物进行治疗,以提高治疗有效率,同时还应根据影响因素加强防范,以降低其发生率。

Objective To explore pathogenic characteristics,drug resistance and risk factors of systemic lupus erythematosus with fungal infection.Methods Clinical data of 78 cases of patients with systemic lupus erythematosus with fungal infection treated in the hospital were analyzed retrospectively.Pathogenic bacteria and drug resistance test were carried out,and related factors of influencing systemic lupus erythematosus with fungal infection were analyzed with multi factors Logistic regression.Results Among554 cases of patients with systemic lupus erythematosus in the study,78 cases were with fungal infection,accounting for 14.08%.The incidence rates of respiratory tract,urinary tract infection were 29.49% and 25.64% respectively.And in 78 cases of fungal culture results,a total 102 strains of fungal were found out,including Candida albicans and Staphylococcus aureus,which accounted for 52.94% and 31.37%.Multi Logistic regression analysis showed independent risk factors which influenced the infection were hospitalization time longer than 4 weeks,24 hurinary protein more than or equal to 3.5 g,the number of organ damage involving more than or equal to 3,antibiotic applied time more than or equal to two weeks,the white blood cell count over 3×109/L,CD4＋lower than 200 per microliter and complement C3 lower than 0.8 mg/L.Conclusion There are many factors influencing systemic lupus erythematosus with fungal infection,and the clinic should base on infection location and fungal infection types to improve the effect.Meanwhile,it should strengthen prevention according to the influencing factors,so as to reduce the infected incidence.