类风湿关节炎患者肺部感染的临床特点及其危险因素分析  

Clinical characteristics and risk factors of pulmonary infection in patients with rheumatoid arthritis

作　　者：孙甜甜 徐婷[1] 陈璐[2] 狄佳[3] 王雯 吴敏[1] Sun Tiantian;Xu Ting;Chen Lu;Di Jia;Wang Wen;Wu Min(Department of Rheumatology and Immunology,the Third Affiliated Hospital of Soochow University,Changzhou 213000,China;Department of Endocrinology and Metabolism,the Third Affiliated Hospital of Soochow University,Changzhou 213000,China;Department of Nephrology,the Third Affiliated Hospital of Soochow University,Changzhou 213000,China)

机构地区：[1]苏州大学附属第三医院免疫风湿科,江苏常州213000 [2]苏州大学附属第三医院内分泌与代谢科,江苏常州213000 [3]苏州大学附属第三医院肾内科,江苏常州213000

出　　处：《临床荟萃》2020年第1期47-53,共7页Clinical Focus

基　　金：江苏现代医院管理研究自身免疫病合并感染风险管理评分系统的构建和临床应用（JSY-3-2019-107）;江苏现代医院管理研究三级公立医院在医联体感染管理中的机制研究（JSY-3-2019-098）;江苏省高层次卫生人才“六个一工程”拔尖人才科研项目羟氯喹调控瘦素治疗原发性干燥综合征的疗效及机制研究（LGY2019023）;常州市科技计划资助瘦素调节肠道菌群在胃癌中的作用机制研究（CJ20190103）;常州市卫生计生委重大科技项目瘦素调节肠道菌群在原发性干燥综合征的作用机制及临床应用研究（ZD201707）;江苏省博士后科研资助计划瘦素调节滤泡辅助性T细胞在原发性干燥综合征发病中的作用及机制研究（2019K260）;江苏省妇幼健康科研项目免疫相关性不良妊娠风险管理评分系统的构建及临床应用（F201837）;常州市卫计委重大科技项目常州地区痛风患者的规范化诊疗和精准医疗模式研究（ZD201607)

摘　　要：目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者合并肺部感染的临床特点及危险因素。方法回顾性研究合并肺部感染RA住院患者52例和未合并感染RA住院患者200例临床资料,其中严重感染21例,分析RA合并肺部感染及肺部严重感染的临床特点及危险因素。结果RA患者中合并肺部感染52例,痰培养送检阳性率为36.54%,检出25株病原菌,其中细菌10株,支原体3株,真菌12株;肺部感染相关危险因素分析提示年龄>60岁、病程≥10年、吸烟、慢性肺疾病、激素治疗为独立危险因素,抗风湿药物(DMARDs)治疗为保护因素。肺部严重感染相关危险因素分析提示病程≥10年、吸烟、慢性肺疾病、激素治疗、补体C4降低为独立危险因素,DMARDs治疗为保护因素。结论RA患者肺部感染的致病菌主要是真菌和细菌,当RA患者病程≥10年、吸烟、合并慢性肺疾病、激素治疗、补体C4降低时应注意肺部严重感染风险,DMARDs治疗可以降低RA患者肺部感染的风险。Objective To investigate the clinical features and risk factors of pulmonary infection in patients with rheumatoid arthritis(RA).Methods The clinical data of 52 RA patients with pulmonary infection and 200 RA patients without pulmonary infectionwere retrospectively reviewed.Among them,21 patients were severely infected.The clinical features and risk factors of RA complicated with pulmonary infection and severe pulmonary infection were analyzed.Results There were 52 cases of pulmonary infection in RA patients,the positive rate of sputum culture was 36.54%.Totally 25 strains of pathogens were detected,including 10 strains of bacteria,3 strains of mycoplasma and 12 strains of fungi.The analysis of related factors of pulmonary infection indicated that the independent risk factors included age(>60 years),RA duration of(≥10 years),smoking,chronic lung disease,use of corticosteroids and the decrease of complement C4,while the use of DMARDs was a protective factor.The analysis of related factors of severe pulmonary infection indicated thatindependent risk factors included RA duration(≥10 years),smoking,chronic lung disease,use of corticosteroids,and decrease of complement C4,while the use of DMARDs was a protective factor.Conclusion The pathogens of pulmonary infection in RA patients were mainly fungi and bacteria.Risk factors for pulmonary infection should be considered when deciding treatment for RA patient.The use of DMARDs can reduce the risk of pulmonary infection in RA patients.

关 键 词：类风湿关节炎 肺部感染 危险因素 

分 类 号：R593.22[医药卫生—内科学]