抗中性粒细胞胞质抗体相关性血管炎患者治疗后继发感染的危险因素  

Risk factors for secondary infection in the treatment with anti-neutrophil cytoplasmic antibody-associated vasculitis

作　　者：包娇 程一春 邵菊芳 代维[1] 李月强 何晓峰[1] 韩敏[1] 葛树旺[1] 徐钢[1] Bao Jiao;Cheng Yichun;Shao Jufang;Dai Wei;Li Yueqiang;He Xiaofeng;Han Min;Ge Shuwang;Xu Gang(Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)

机构地区：[1]华中科技大学同济医学院附属同济医院肾内科,武汉430030

出　　处：《中华肾脏病杂志》2019年第5期351-358,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81670633、81570667、81470948、91742204、81761138041);国家重点研发计划项目精准医学研究专项(2016YEC0906103);国家科技支撑计划(2013BAI09B06、2015BAI12B07).

摘　　要：目的回顾性分析抗中性粒细胞胞质抗体(ANCA)相关性血管炎(AAV)治疗并发感染患者的临床特征及危险因素。方法收集2012年1月1日至2017年12月31日在华中科技大学同济医学院附属同济医院肾内科住院确诊为AAV患者的临床资料。诱导缓解期治疗方案包括单用激素、激素联合环磷酰胺和激素联合其他免疫抑制剂。终点事件定义为中重度感染的发生。绘制患者治疗继发感染的生存曲线直观反映患者感染发生的时间。运用单因素及多因素Logistic回归分析AAV治疗并发感染的危险因素,并绘制淋巴细胞计数诊断中重度感染的受试者工作特征(ROC)曲线,评估其对中重度感染的预测价值。结果共纳入118例AAV患者,其中男性57例,女性61例,中位年龄57.5岁(16~87岁)。共63例(53.4%)AAV患者发生88次感染,54次(61.4%)发生在治疗后6个月内,其中前3个月内发生了46次(52.3%)。生存曲线显示感染主要发生在治疗开始后6个月内,尤其是前3个月。感染最常见部位是肺(62.5%),最常见病原体是细菌(51.1%)。多因素Logistic回归显示肺部受累(OR=4.44,95%CI 1.59~12.41)、随访中淋巴细胞中度减少(OR=5.69,95%CI 2.05~15.85)和重度减少(OR=36.28,95%CI 3.45~381.17)是AAV患者治疗继发感染的独立危险因素(均P<0.05)。ROC曲线显示淋巴细胞计数诊断中重度感染的曲线下面积为0.767(95%CI 0.64~0.89,P<0.05);以淋巴细胞计数小于0.49×109/L(临界点),预测发生重度感染的敏感度为83.9%,特异度为71.9%。结论肺部受累、随访中淋巴细胞中度减少和重度减少是AAV患者治疗继发感染的独立危险因素,临床中应提高警惕,及时调整治疗方案,避免感染的发生。Objective To investigate the clinical characteristics and risk factors of secondary infection in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods One hundred and eighteen patients newly diagnosed with AAV at the institute of nephrology, Tongji hospital affiliated to Huazhong university of science and technology, from 2012 to 2017, were analyzed retrospectively. Induction therapy included single corticosteroids, combination of corticosteroids with cyclophosphamide and combination of corticosteroids with other immunosuppressive agents. End point was defined as moderate to severe infection which was diagnosed by the clinical and radiological manifestation as well as microbiological evidences. The infection-related survival curve was drawn to reflect the time when the infection occurred. The clinical baseline variables in patients with and without infection were compared. Multivariate Logistic regression model was used to determine the independent predictors of infection. Receiver-operating characteristic curve (ROC) was plotted for evaluating the predictive value of lymphocyte on moderate to severe infection. Results During follow-up of median 3 months (1-30 months), 88 infection episodes were found in 63 (53.4%) patients, of which 54 times (61.4%) occurred within 6 months after treatment, 46 times (52.3%) happened within 3 months after treatment. The most common organ of infection was lung (62.5%), and the most common pathogen was bacteria (51.1%). Multivariate Logistic regression model showed that lung involvement (OR=4.44, 95%CI 1.59-12.41), moderate reduction of lymphocyte in follow-up (OR=5.69, 95%CI 2.05-15.85) and severe lymphocyte reduction (OR=36.28, 95%CI 3.45-381.17) were independent risk factors of secondary infection in AAV patients (all P<0.05). ROC curve showed that the area under the curve of lymphocyte as a predictor of severe infection was 0.767 (95%CI 0.64-0.89, P<0.05). Based on lymphocyte less than 0.49×109/L which was the cut-off value for predicting seve

关 键 词：抗体 抗中性白细胞胞质 感染 危险因素 淋巴细胞减少 抗中性粒细胞胞质抗体相关性血管炎 

分 类 号：R593.2[医药卫生—内科学]