系统性红斑狼疮住院患者肺部感染病原菌及感染高危因素分析  

The risk factors and pathogenic bacteria of pulmonary infection in patients of different ages with systemic lupus erythematosus

作　　者：郭冬芳 韩会敏 刘续春 刘喆 孟庆防 GUO Dongfang;HAN Huimin;LIU Xuchun;LIU Zhe;MENG Qingfang(Department of Laboratory,Zhumadian Central Hospital,Zhumadian,Henan Province,463000;Department of Rheumatology and Immunology,Zhumadian Central Hospital,Henan Province,463000.)

机构地区：[1]驻马店市中心医院检验科,河南驻马店463000 [2]驻马店市中心医院风湿免疫科,河南驻马店463000

出　　处：《实验与检验医学》2020年第3期445-448,共4页Experimental and Laboratory Medicine

基　　金：国家科技支撑计划(2018BAI09B06)。

摘　　要：目的探讨系统性红斑狼疮(SLE)住院患者肺部感染病原菌及感染高危因素,为预防SLE肺部感染的发生及临床用药提供参考。方法选取2016年1月-2017年12月在医院住院治疗的SLE患者100例,收集患者呼吸道痰液,行细菌培养、分离及菌种鉴定,分析结果。结果 27例患者发生肺部感染,肺部感染率为27.00%,感染患者痰液培养出病原菌29株,其中革兰阴性菌18株、革兰阳性菌9株、真菌2株,分别占62.07%、31.03%、6.90%,主要病原菌为鲍曼不动杆菌8株、凝固酶阴性葡萄球菌6株、肺炎克雷伯菌5株,分别占27.59%、20.69%、17.24%。年龄≥60岁、病程≥5年、住院时间≥4周、应用免疫抑制剂、应用广谱抗菌药物、肾功能不全、浆膜炎、累及器官≥3个、C3<0.8g/L、24h尿蛋白≥3.5g/24h、白细胞计数≥3.5×109/L时肺部感染率分别为50.00%、35.29%、34.85%、54.55%、46.15%、46.81%、42.22%、38.98%、36.21%、37.29%、41.67%,高于年龄<60岁、病程<5年、住院时间<4周、未应用免疫抑制剂、未应用广谱抗菌药物、无肾功能不全、无浆膜炎、累及器官<3个、C3≥0.8g/L、24h尿蛋白<3.5g/24h、白细胞计数<3.5×109/L时的22.62%、9.38%、11.76%、13.43%、14.75%、9.43%、14.55%、9.76%、14.29%、12.20%、18.75%,比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示住院时间≥4周、应用免疫抑制剂、应用广谱抗菌药物、累及器官≥3个、C3<0.8g/L、24h尿蛋白≥3.5g/24h、白细胞计数≥3.5×109/L是引起患者发生肺部感染的高危因素(P<0.05)。结论引起SLE住院患者肺部感染的病原菌以革兰阴性菌为主,导致肺部感染发生的高危因素较多,应针对相关高危因素进行干预。Objective To explore the risk factors and pathogenic bacteria of pulmonary infection in patients of different ages with systemic lupus erythematosus(SLE),to provide reference for the prevention and clinical medication of pulmonary infection in SLE.Methods A total of 100 cases of SLE patients in January 2016-December 2017,were enrolled,the patient's respiratory sputum were collected.Bacterial culture,isolation and identification were performed,and the results were analyzed.Results The pulmonary infection were identified in 27 cases of the elderly group,the infection rate were 27.00%,among 29 strains of pathogenic bacteria,there were 18 strains of gram-negative bacteria(62.07%)and 9 strains of gram-positive bacteria(31.03%),2 strains of fungi(6.90%),there were 8 strains of acinetobacter baumannii(27.59%)and 6 strains of coagulase negative staphylococcus(20.69%),5 strains of klebsiella pneumonia(17.24%).Age≥60 years,disease course≥5 years,hospitalization time≥4 weeks,application of immunosuppressive agents,application of broad-spectrum antibacterial drugs,renal insufficiency,serositis,involving the organs≥3,C3<0.8g/L,24 h urine protein≥3.5g/24h,WBC≥3.5×109/L,the pulmonary infection rate were 50.00%and 35.29%,34.85%,54.55%,46.15%,46.81%,42.22%,38.98%,36.21%,37.29%,41.67%.Age<60 years,disease course<5 years,hospitalization time<4 weeks,non application of immunosuppressive agents,non application of broad-spectrum antibacterial drugs,non renal insufficiency,non serositis,involving the organs<3,C3≥0.8g/L,24 h urine protein<3.5g/24h,WBC≥3.5×109/L,the pulmonary infectionrate were 22.62%and 9.38%,11.76%,13.43%,14.75%,9.43%,14.55%,9.76%,14.29%,12.20%,18.75%,the difference was statistically significant(P<0.05).Multi Logistic regression analysis showed independent risk factors which influenced the infection were hospitalization time≥4 weeks,application of immunosuppressive agents,application of broad-spectrum antibacterial drugs,involving the organs≥3,C3<0.8g/L,24 h urine protein≥3.5g/24h,WBC≥3.5×109

关 键 词：系统性红斑狼疮 肺部感染 病原菌 高危因素 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]