系统性红斑狼疮并发感染的流行病学研究

目的了解系统性红斑狼疮(SLE)患者并发感染的流行病学特征。方法前瞻性队列随访研究SLE患者门诊、住院及其随访，观察、记录并统计分析SLE患者的临床和实验室资料。结果371例SLE患者随访观察1年，211例患者(56．8％)发生341次感染(医院感染105次)，其中99例患者发作≥2次感染，79例患者(37．4％)发生≥2种病原体的混合感染；检出细菌感染191次(56．0％)，难治性条件致病菌明显增多，病毒感染102次(29．9％)，真菌感染42次(12．3％)，寄生虫类6次(1．8％)；呼吸道及皮肤粘膜是本组SLE患者最常见感染部位；感染组较非感染组，平均住院日、SLEDAI、白细胞／淋巴细胞减少、尿蛋白水平、补体C3水平和1年死亡率差异显著；单因素Logistic回归分析显示SLEDAI＞9、尿蛋白定量＞2．0g／24h、MP冲击累积量＞1．5g／疗程、CTX冲击量＞1．5／月和平均激素日剂量＞0．5mg／kg与SLE患者并发感染有明显相关性；多因素Logistic逐步回归分析显示，只有尿蛋白定量＞2．0g／24h、MP冲击累积量＞1．5g／疗程、CTX冲击量＞1．5／月和平均激素日剂量＞0．5mg／kg是SLE患者并发感染独立危险因素。结论SLE患者并发感染的致病菌主要为细菌感染，狼疮肾损害程度和免疫抑制治疗是引起SLE患者感染的独立危险因素。

Epidemiology of Systemic Lupus Erythematosus Patients with Infection

OBJECTIVE To know the epidemiologic characteristics of systemic lupus erythematosus (SLE) patients with infection. METHODS A prospective cohort study was used. RESULTS Of 371 cases of SLE patients followed with one year, there were 211 cases (56.8%) and 341 episodes of infections, 99 cases with two episodes of infections, 79 cases with two or more kinds of pathogens overlap infections. Checked pathogens included bacteria (191 episodes, 56%), viruses (102 episodes, 29.9%), fungi (42, 12.3% ) and others (1.8%). There was significant difference in mean hospital time, SLEDAI, leukopenia/lymphopenia, 24h urine protein level, complement C3 level and one year death rate between infected SLE patients and control ones. Univariate Logistic regressions showed SLEDAI >9, urine protein >2.0 g/24 h, IV methylprednisolone (MP) cumulative dose (>1.5 g/3 d,) IV CTX cumulative dose >1.5 g/m and mean prednisone dose >30 mg/d, respectively correlated with infection, but multivariate regressions showed only urine protein >2.0 g/24 h, IV methylprednisolone (MP) cumulative dose >1.5 g/3d, IV CTX cumulative dose >1.5 g/m and mean prednisone dose >30 mg/d were independent risk factors for infection in patients with SLE. CONCLUSIONS Bacteria are main infective pathogens, and the lupus nephritis and immunosuppressive drugs therapy are major risk factors.