系统性红斑狼疮合并感染的临床特点

Clinical Features of Systemic Lupus Erythematosus Infection

目的探讨系统性红斑狼疮合并感染的临床特点。方法回顾性分析2017年1月~2019年1月在运城市中心医院住院的215例系统性红斑狼疮患者,根据是否合并感染分为感染组91例和非感染组124例,分析两组的临床特点、系统性红斑狼疮合并感染的菌群种类、感染部位。结果感染组的血清白蛋白较非感染组低,24h尿蛋白定量、血沉、CRP、降钙素原、ANA滴度较非感染组高,感染组SLEDAI值高于非感染组,差异均有统计学意义(P<0.05);感染组心脏受累者(17.58%)、肺部受累(16.48%)、肾脏受累(47.25%)分别高于非感染组的3.23%、4.84%、22.58%,差异均有统计学意义(P<0.05)。合并感染患者中呼吸道感染45例(49.45%),泌尿道感染25例(27.47%),消化道感染5例(5.49%),中枢神经系统感染2例(2.20%),皮肤黏膜感染14例(15.38%)。感染菌群中以细菌感染居多,革兰氏阴性菌居多,多为大肠埃希菌;其他为真菌、结核分支杆菌、带状疱疹、EB病毒、巨细胞病毒感染。结论系统性红斑狼疮病情活动合并低蛋白血症、尿蛋白阳性,累及心脏、肺部、肾脏者更易合并感染。感染菌群较多,部位分布广泛,临床工作中应在积极治疗原发病的同时,警惕合并感染,合理选择药物,提高诊疗水平。

Objective To investigate the clinical features of systemic lupus erythematosus infection.Methods A retrospective analysis of 215 patients with systemic lupus erythematosus admitted to Yuncheng Central Hospital from January 2017 to January 2019 was conducted according to whether the infection was classified into 91 patients in the infection group and 124 patients in the non-infected group.Characteristics,types of systemic lupus erythematosus infection,infection site.Results The serum albumin of the infected group was lower than that of the non-infected group.The 24-hour urine protein quantitation,erythrocyte sedimentation rate,CRP,procalcitonin,and ANA titer were higher than those in the non-infected group.The SLEDAI value of the infected group was higher than that of the non-infected group,the difference was statistically significant(P<0.05);the affected group(17.58%),lung involvement(16.48%),and renal involvement(47.25%)were higher than the non-infected group 3.23%,4.84%,22.58%,respectively,the difference was statistically significant(P<0.05).Among the patients with infection,45 cases(49.45%)had respiratory infection,25 cases(27.47%)had urinary tract infection,5 cases(5.49%)had digestive tract infection,2 cases(2.20%)had central nervous system infection,and 14 cases had skin mucosal infection(15.38%).Infected flora is mostly bacterial infection,Gram-negative bacteria are mostly,mostly Escherichia coli;others are fungi,Mycobacterium tuberculosis,herpes zoster,Epstein-Barr virus,cytomegalovirus infection.Conclusion Systemic lupus erythematosus is associated with hypoproteinemia and urinary protein,and it is more likely to be infected with the heart,lungs and kidneys.There are many infected bacteria and extensive distribution.In clinical work,we should actively treat the primary disease,be alert to the infection,rationally select drugs,and improve the level of diagnosis and treatment.