高活动度初发系统性红斑狼疮合并感染回顾性队列研究  

Infections in newly diagnosed systemic lupus erythematosus patients with high disease activity:a retrospective cohort study

作　　者：周宇宏 王海婷[2] 庾利琴 吴万龙[2] 耿时凯 孙芳芳[2] 章丹婷 陈怡[1] 叶霜[2] Zhou Yuhong;Wang Haiting;Yu Liqin;Wu Wanlong;Geng Shikai;Sun Fangfang;Zhang Danting;Chen Yi;Ye Shuang(Department of Emergency and Critical Care Medicine,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200001,China;Department of Rheumatology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200001,China;Department of Rheumatology,Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine,Suzhou 215127,China)

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,200001 [2]上海交通大学医学院附属仁济医院风湿科,200001 [3]上海交通大学医学院附属苏州九龙医院风湿科,215127

出　　处：《中华风湿病学杂志》2021年第10期654-658,共5页Chinese Journal of Rheumatology

基　　金：上海市促进市级医院临床技能与临床创新能力三年行动计划(重大临床研究项目)(SHDC2020CR1015B)。

摘　　要：目的研究初发SLE住院患者合并感染的临床特征及危险因素。方法回顾性收集2013年5月至2018年12月在上海仁济医院南院区风湿科住院的病程<1个月的初发SLE患者194例。按照随访1年内是否发生感染,分为感染组(51例)和未感染组(143例)。按数据分布类型选用相应的统计方法:t检验和χ2检验;多元分析采用Cox回归方法和Log-rank生存分析。结果194例初发SLE患者在1年的随访期间,死亡21例占11%,发生感染51例占26%。在51例感染中,常见的感染部位依次为肺部(34例占67%)、中枢神经系统(9例占18%)及血流(9例占18%)。在42例病原学明确的病例中,最常见的病原菌为细菌(19例占45%),以革兰阴性菌为主;其次为真菌(18例占43%)及分枝杆菌(7例占17%)。根据感染发生时间分析,75%(38/51)的感染发生在SLE诊断后的前3个月,且这一群体的病死率显著高于未感染组[(39%,15/38)和(2%,3/143),χ2=42.59,P<0.01]。对比初发SLE 3个月内感染组与未感染组基线期数据提示,2组在年龄(≥40岁)、SLEDAI积分(>10分)、SLE国际临床协作组/ACR SLE损伤指数(SDI)积分(≥1分)、心包积液、LN、胃肠道血管炎、糖尿病、淋巴细胞计数下降(<0.8×109/L)、血小板计数下降(<100×109/L)、血清肌酐升高(>104 mmol/L)及球蛋白下降(<20 g/L)方面差异有统计学意义(P<0.05)。进一步行Cox多因素回归提示合并LN、胃肠道血管炎及淋巴细胞计数<0.8×109/L为初发SLE 3个月内感染发生的独立危险因素。结论在初发SLE患者中,低淋巴细胞血症、合并狼疮肾炎及胃肠道血管炎是并发感染的危险因素;熟悉上述危险因素将有助于临床医生及时恰当地干预,以期改善患者预后。Objective To determine the characteristics of hospitalized newly diagnosed systemic lupus erythematosus(SLE)patients with high disease activity,and identify the risk factors.Methods Data from 194 newly diagnosed SLE patients at Shanghai Renji Hospital between May 2013 and December 2018 were collected retrospectively.All patients were followed up for 1 year or until death.Patients'demographic,clinical,and laboratory characteristics on admission and medication history were retrospectively collected as baseline data.Patients were divided into two groups,lupus patients with infection(51 cases)and lupus patients without infection(143 cases).The method of univariate analysis of data depended on the data distribution type.Variables that suggested association in the univariate analysis(P<0.05)were entered into Cox regression model.Results Among 194 patients with newly diagnosed SLE,21 cases(11%)died and 51 cases(26%)were infected during 1-year follow-up.Regarding the infection site,34 cases(67%)had lung infection,9 cases(18%)had central nervous system infection and 9 cases(18%)had blood stream infection.Common bacteria were identified in 19 cases(45%),followed by fungal infection in 18 cases(43%)and mycobacterium infection in 7 cases(17%).Among the 51 patients with infection,38 patients(75%)had infection within the first 3 months after diagnosis,and mortality in this group was significantly higher than that in the uninfected group(39%,15/38 vs 2%,3/143,P<0.01).Comparing baseline parameters between patients with 3-month infection and without,significant differences(P<0.05)were detected in age(≥40 years),systemic lupus erythematosus disease activity index(SLEDAI)score(>10 points),Systemic Lupus International Collaborating Clinic(SLICC)/American College of Rheumatology(ACR)systemic lupus erythematosus damage index(SDI)(≥1 point),pericardial effusion,nephritis,gastrointestinal vasculitis,diabetes,lymphocyte count<0.8×109/L platelet count<100×109/L,serum creatinine>104 mmol/L and serum globulin level<20 g/L.Finally,clin

关 键 词：红斑狼疮 系统性 感染 危险因素 

分 类 号：R593.241[医药卫生—内科学]