系统性红斑狼疮合并持续炎症-免疫抑制-分解代谢综合征

Persistent inflammation-immunosuppression-catabolism syndrome in patients with systemic lupus erythematosus

目的:回顾性分析系统性红斑狼疮(SLE)合并持续炎症-免疫抑制-分解代谢综合征(PICS)的临床特征,分析影响患者预后的危险因素。方法:本研究纳入2010年7月至2018年7月东部战区总医院国家肾脏疾病临床医学研究中心重症监护病房(ICU)住院时间>14d的SLE患者96例,根据PICS诊断标准分为PICS组(61例,SLE合并PICS患者)和非PICS组(35例,SLE未合并PICS患者)。比较两组患者在ICU期间的临床特征和预后,对各组患者死亡的危险因素进行多元回归分析。结果:PICS组患者ICU住院时间较非PICS组长,C反应蛋白、降钙素原、白细胞介素6等炎症反应指标明显高于非PICS组,总淋巴细胞计数、CD3^+、CD4^+、CD8^+、CD20^+淋巴细胞计数明显低于非PICS组(P<0.01)。PICS组血红蛋白、血小板、血清肌酐、血尿素氮水平、SLE疾病活动指数低于非PICS组(P<0.05),入住ICU前2个月泼尼松累计用量PICS组多于非PICS组患者(P=0.025)。PICS组合并脓毒症、急性呼吸窘迫综合征、革兰阳性菌、革兰阴性菌、真菌及二重感染、需要机械通气的比例高于非PICS组(P<0.05)。随访终点时,PICS组累计生存率为50.82%,肾脏存活率为31.15%,非PICS组累计生存率为85.71%,肾脏存活率为45.71%。多因素COX模型发现,ICU期间APACHE-Ⅱ评分、总淋巴细胞计数是SLE合并PICS患者死亡的独立危险因素。结论:SLE合并PICS的患者ICU住院时间较长,继发感染风险大,生存率明显低于非PICS患者。APACHE-Ⅱ评分高和总淋巴细胞计数低的PICS患者死亡风险较大。

Objective:This study was aimed to evaluate clinical characteristics and prognosis of systemic lupus erythematosus(SLE)with persistent inflammation-immunosuppression-catabolism syndrome(PICS).Methodology:We retrospectively analyzed the patients with SLE who were admitted to the renal ICU for over 14 days of Jinling Hospital from July 2010 to July 2018.According to diagnostic criteria of PICS,we divided the patients into PICS group and a non-PICS group.We compared the clinical feature and prognosis,and also performed a multivariate COX regression analysis on the risk factors for death on SLE patients with PICS.Results:A total of 96 SLE patients met the inclusion standard of this study,including 61 PICS patients and 35 non-PICS patients.The PICS group patients had a longer length of stay in ICU,higher inflammatory indicators such as CRP,PCT and IL-6,and lower immune function such as total lymphocyte count,CD3^+,CD4^+,CD8^+and CD20^+lymphocytes than these of non-PICS group(P<0.01).Hemoglobin,platelet,serum creatinine,serum blood urea nitrogen and SLE-DAI score in PICS group were lower than those in non-PICS group(P<0.05).The PICS combined with sepsis,ARDS,mechanical ventilation,gram-positive bacteria,negative bacteria,fungus,and superinfection were higher than non-PICS group(P<0.05).The long-term survival rate was 50.82%in the PICS group and 85.71%in the non-PICS group until January 2020.The renal survial rate was 31.15%in PICS group and 45.71%in non-PICS group.Multivariate COX regression found that APACHE-Ⅱscore and total lymphocyte count during ICU were independent risk factors for death in SLE patients with PICS.Conclusion:Patients with SLE complicated with PICS had longer ICU stay,higher risk of secondary infection,significantly lower survival rate than non-PICS patients.PICS patients with high APACHE-Ⅱscore and low total lymphocyte count had poor prognosis.