重症医学科内系统性红斑狼疮合并脓毒症患者临床表现和预后分析  

Clinical Presentations and Prognostic Factors in Systemic Lupus Erythematosus Patients with Sepsis Admitted to Intensive Care Unit

作　　者：杨小蕾[1] 廖雪莲[1] 韩莉[1] 康焰[1] 

机构地区：[1]四川大学华西医院重症医学科,成都610041

出　　处：《四川大学学报（医学版）》2016年第4期594-598,共5页Journal of Sichuan University(Medical Sciences)

基　　金：卫生行业科研专项项目(No.201202011)资助

摘　　要：目的讨论重症医学科（ICU）内系统性红斑狼疮（SLE）合并脓毒症患者的临床特点和预后的影响因素。方法回顾分析2010~2014年入住ICU的SLE合并脓毒症的临床及实验室数据包括主要器官受累情况,SLE疾病活动指数（systemic lupus erythematosus disease activity index,SLEDAI）,急性生理和慢性健康状况评分（acute physiology and chronic health evaluation,APACHEⅡ）,感染部位及病原体检查结果等,并采用多因素logistic回归分析预后相关的危险因素。结果共纳入50例患者,以女性为主（86%）,SLEDAI（15.8±6.3）分,APACHEⅡ（25.8±6.5）分,ICU内死亡率为46.0%,最常见的死亡原因为多器官衰竭,进入ICU的最常见原因是呼吸衰竭。感染以G-菌为主。多变量logistic回归提示ICU内消化道出血、感染性休克及较高的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）与预后相关。结论消化道出血、感染性休克和较高的APACHEⅡ评分是ICU内SLE合并脓毒症患者预后的不良因素。Objective To explore the characteristics and prognostic factors associated with the death of systemic lupus erythematosus（SLE）with sepsis in intensive care unit（ICU）.Methods Clinical and laboratory documents of SLE patients with sepsis from Jan 2010 to Dec 2014 were retrospectively analyzed,including active organ involvement,systemic lupus erythematosus disease activity index（SLEDAI）score,acute physiology and chronic health evaluation（APACHE）Ⅱscore,sites of infection and organisms cultured.Prognostic factors were analyzed by multivariate logistic regression analysis.Results Included patients were mainly females（86%,43/50）.For all patients,SLEDAI was 15.8±6.3;APACHEⅡ was 25.8±6.5;the mortality rate during ICU hospitalization was 46%.The most common causes of death and admission were multiple organ dysfunction syndrome and respiratory failure,respectively.The most common pathogen was Gram-negative bacteria.Multivariate logistic regression analysis suggested that gastrointestinal bleeding,septic shock and high APACHEⅡscore were independent risks for mortality.Conclusion Gastrointestinal bleeding,septic shock and high APACHEⅡscore were risk factors in SLE patients with sepsis in ICU.

关 键 词：系统性 红斑狼疮 脓毒症 重症医学科 预后 

分 类 号：R459.7[医药卫生—急诊医学] R593.241[医药卫生—治疗学]