系统性红斑狼疮合并尿路感染患者病原菌分布特点和影响因素分析

Distribution Characteristics of Pathogens and Influencing Factors in Patients with Systemic Lupus Erythematosus Complicated with Urinary Tract Infection

目的:分析系统性红斑狼疮(SLE)合并尿路感染(UTI)病原菌特点以及影响因素。方法:回顾性分析2016年5月-2020年10月于连云港市第二人民医院诊断和治疗的91例SLE患者的临床资料。根据是否合并UTI分为UTI组(35例)和无UTI组(56例),收集所有患者年龄、性别、中段尿培养结果、临床症状、肾功能、血WBC、C3、C4、尿常规结果、系统性红斑狼疮活动指数(SLEDAI)、激素和免疫抑制剂使情况并进行统计分析。结果:共检测病原菌35株,革兰阴性菌(G^(+)菌)24株,占比68.57%,革兰阳性菌(G^(+)菌)5株,占比14.29%,真菌6株,占比17.14%。SLE合并UTI患者以发热和尿道刺激征临床表现为主,2例为无症状性UTI。二元Logistic回归分析表明,泼尼松剂量≥20 mg/d、激素+免疫抑制剂、CRP、尿液细菌计数、尿液WBC均为SLE患者合并UTI的独立影响因素(P<0.05),OR值分别为2.850、2.962、1.464、1.306、1.154。结论:SLE合并UTI病原菌多为大肠埃希菌,均对亚胺培南敏感,激素和免疫抑制剂的使用应注意剂量和使用时间,尿液细菌计数和WBC结果异常时提示可能UTI。

Objective:To analyze the distribution characteristics of pathogens and influencing factors in patients with systemic lupus erythematosus (SLE) complicated with urinary tract infection (UTI).Method:The clinical data of 91 SLE patients diagnosed and treated in Lianyungang Second People’s Hospital from May 2016 to October 2020 were retrospectively analyzed,they were divided into UTI group (n=35) and non UTI group (n=56) according to whether they were complicated with UTI or not.The age,sex,results of culture of middle urinary tract,clinical symptoms,renal function,WBC,C3,C4,urine routine results,systemic lupus erythematosus activity index (SLEDAI),hormone and immunosuppressant were collected and analyzed.Result:A total of 35 strains of pathogenic bacteria were detected,including 24 strains of gram negative bacterium (G^(+)),accounting for 68.57%,5 strains of gram positive bacterium (G^(+)),accounting for 14.29% and 6 strains of fungi,accounting for 17.14%.The main clinical manifestations of SLE patients with UTI were fever and urethral irritation,but two cases were asymptomatic UTI.Binary Logistic regression analysis showed that prednisone dose≥20 mg/d,hormone + immunosuppressant,CRP,urine bacterial count and urine WBC were independent influencing factors of UTI in SLE patients (P<0.05),and the OR values were 2.850,2.962,1.464,1.306 and 1.154 respectively.Conclusion:Most of the pathogenic bacteria of SLE complicated with UTI are Escherichia coli,which are sensitive to imipenem.The dosage and time of hormone and immunosuppressant should be paid attention to.Abnormal urine bacterial count and WBC results may indicate UTI.