系统性红斑狼疮合并感染的诊断与鉴别的研究进展

Research advances in distinguishing infections vs.flares in patients with systemic lupus erythematosus

系统性红斑狼疮(SLE)是一种慢性自身免疫性疾病,可累及多个系统。SLE病人具有较高的感染率,可能是因为长期的免疫抑制治疗以及疾病本身造成的免疫系统异常等综合因素所致,但鉴别SLE发热是感染还是病情活动是极其困难的。活动指数对判断狼疮病人疾病活动是有用的,但临床和生物学的异常可能很难区别疾病活动还是合并感染。几种生物标志物被认为是鉴别SLE活动或者感染的潜在工具,如C-反应蛋白和原降钙素。但仅使用一种生物标志物去确认或者否认感染是不可行的,这就需要新的评分包含多种生物标志物,这可能是区分感染和病情活动新的方法,该文综述了近年关于SLE合并感染的诊断与鉴别的研究进展。

Systemic lupus erythematosus(SLE)is a chronic autoimmune disease involving multiple systems.Patients with SLE are highly susceptible to infections due to the combined effects of their immunosuppressive therapy and the abnormalities of the immune system that the disease itself causes.The differentiation of SLE activity from infection in a febrile patient with SLE is extremely difficult.Activity indexes are useful to identify patients with lupus flares but some clinical and biological abnormalities may,however,make it difficult to differentiate flares from infection.Several biological markers are now recognized as potential tools to establish the difference between SLE activity and infection,including C-reactive protein(CRP)and procalcitonin.It is possible,however,that the use of only one biomarker is not sufficient to confirm or discard infection.This means that new scores,which include different biomarkers,might represent a better solution for differentiating these two clinical pictures.This review article describes several markers that are currently used,or have the potential,to differentiate infection from SLE flares.