红斑狼疮,系统性%败血症%临床特征%影响因素
紅斑狼瘡,繫統性%敗血癥%臨床特徵%影響因素
홍반랑창,계통성%패혈증%림상특정%영향인소
Lupus erythematosus,systemic%Sepsis%Clinical characteristics%Influencing factor
目的 探讨系统性红斑狼疮(SLE)发生败血症感染的影响因素和临床表现特点.方法 本院2005-2010年住院确诊的SLE伴败血症患者21例为病例组,随机选择相同时间内住院的活动期SLE患者21例为对照组,分析比较2组患者的临床和实验室指标.计量数据以-x±s表示,组间比较采用t检验,计数资料间比较采用X2检验,相关性分析采用Spearman相关分析法.结果 与对照组比较,病例组患者最高体温[(39.4±0.6)与(37.2±0.4)℃,t=13.403,P=0.000]、高热(体温≥39℃)发生率(71％与5％,X2=19.788,P=0.000)、周围血白细胞总数[(10.2±4.6)×109/L和(6.2±2.5)×109/L,t=3.469,P=0.001)]、中性粒细胞计数[(8.3±4.5)与(4.5±2.1)×109/L,t=3.559,P=0.001]、C反应蛋白(CRP)水平[(74±59)与(5±4) mg/L,t=5.398,P=0.000]、乳酸脱氢酶(LDH)水平[(444±343)与(225±144) U/L,t=5.398,P=0.000]均显著升高,其中CRP升高分别超过对照组和正常值的15倍和20倍.血清白蛋白水平[(29±9)与(35±7) g/L,t=2.688,P=0.011]、维持治疗的羟氯喹剂量[(0.11±0.08)与(0.17±0.09) g/d,t=2.331,P=0.025]、抗SSA抗体阳性率(38％与71％,X2=4.709,P=0.03)和抗SSB抗体阳性率(0与43％,X2=11.455,P=0.001),病例组均显著低于对照组.相关分析显示:病例组SLEDAI分别与SLE病程(r=0.514,P=0.017)、周围血白细胞总数(r=0.552,P=0.010)、中性粒细胞计数(r=0.545,P=0.0ll)呈正相关,中性粒细胞计数与血LDH (r=0.482,P=0.032)、CRP(r=0.606,P=0.022)呈正相关,而对照组无这些相关性.结论 当SLE患者出现高热、血白细胞和中性粒细胞计数升高、血LDH升高、CRP升高10倍以上时需警惕败血症感染；SLE活动与败血症感染可能相互影响,且病程长者疾病活动性受影响更明显.低蛋白血症、SSA/SSB抗体阴性可能是败血症感染的危险因素,羟氯喹可能有减少败血症发生的作用.
目的 探討繫統性紅斑狼瘡(SLE)髮生敗血癥感染的影響因素和臨床錶現特點.方法 本院2005-2010年住院確診的SLE伴敗血癥患者21例為病例組,隨機選擇相同時間內住院的活動期SLE患者21例為對照組,分析比較2組患者的臨床和實驗室指標.計量數據以-x±s錶示,組間比較採用t檢驗,計數資料間比較採用X2檢驗,相關性分析採用Spearman相關分析法.結果 與對照組比較,病例組患者最高體溫[(39.4±0.6)與(37.2±0.4)℃,t=13.403,P=0.000]、高熱(體溫≥39℃)髮生率(71％與5％,X2=19.788,P=0.000)、週圍血白細胞總數[(10.2±4.6)×109/L和(6.2±2.5)×109/L,t=3.469,P=0.001)]、中性粒細胞計數[(8.3±4.5)與(4.5±2.1)×109/L,t=3.559,P=0.001]、C反應蛋白(CRP)水平[(74±59)與(5±4) mg/L,t=5.398,P=0.000]、乳痠脫氫酶(LDH)水平[(444±343)與(225±144) U/L,t=5.398,P=0.000]均顯著升高,其中CRP升高分彆超過對照組和正常值的15倍和20倍.血清白蛋白水平[(29±9)與(35±7) g/L,t=2.688,P=0.011]、維持治療的羥氯喹劑量[(0.11±0.08)與(0.17±0.09) g/d,t=2.331,P=0.025]、抗SSA抗體暘性率(38％與71％,X2=4.709,P=0.03)和抗SSB抗體暘性率(0與43％,X2=11.455,P=0.001),病例組均顯著低于對照組.相關分析顯示:病例組SLEDAI分彆與SLE病程(r=0.514,P=0.017)、週圍血白細胞總數(r=0.552,P=0.010)、中性粒細胞計數(r=0.545,P=0.0ll)呈正相關,中性粒細胞計數與血LDH (r=0.482,P=0.032)、CRP(r=0.606,P=0.022)呈正相關,而對照組無這些相關性.結論 噹SLE患者齣現高熱、血白細胞和中性粒細胞計數升高、血LDH升高、CRP升高10倍以上時需警惕敗血癥感染；SLE活動與敗血癥感染可能相互影響,且病程長者疾病活動性受影響更明顯.低蛋白血癥、SSA/SSB抗體陰性可能是敗血癥感染的危險因素,羥氯喹可能有減少敗血癥髮生的作用.
목적 탐토계통성홍반랑창(SLE)발생패혈증감염적영향인소화림상표현특점.방법 본원2005-2010년주원학진적SLE반패혈증환자21례위병례조,수궤선택상동시간내주원적활동기SLE환자21례위대조조,분석비교2조환자적림상화실험실지표.계량수거이-x±s표시,조간비교채용t검험,계수자료간비교채용X2검험,상관성분석채용Spearman상관분석법.결과 여대조조비교,병례조환자최고체온[(39.4±0.6)여(37.2±0.4)℃,t=13.403,P=0.000]、고열(체온≥39℃)발생솔(71％여5％,X2=19.788,P=0.000)、주위혈백세포총수[(10.2±4.6)×109/L화(6.2±2.5)×109/L,t=3.469,P=0.001)]、중성립세포계수[(8.3±4.5)여(4.5±2.1)×109/L,t=3.559,P=0.001]、C반응단백(CRP)수평[(74±59)여(5±4) mg/L,t=5.398,P=0.000]、유산탈경매(LDH)수평[(444±343)여(225±144) U/L,t=5.398,P=0.000]균현저승고,기중CRP승고분별초과대조조화정상치적15배화20배.혈청백단백수평[(29±9)여(35±7) g/L,t=2.688,P=0.011]、유지치료적간록규제량[(0.11±0.08)여(0.17±0.09) g/d,t=2.331,P=0.025]、항SSA항체양성솔(38％여71％,X2=4.709,P=0.03)화항SSB항체양성솔(0여43％,X2=11.455,P=0.001),병례조균현저저우대조조.상관분석현시:병례조SLEDAI분별여SLE병정(r=0.514,P=0.017)、주위혈백세포총수(r=0.552,P=0.010)、중성립세포계수(r=0.545,P=0.0ll)정정상관,중성립세포계수여혈LDH (r=0.482,P=0.032)、CRP(r=0.606,P=0.022)정정상관,이대조조무저사상관성.결론 당SLE환자출현고열、혈백세포화중성립세포계수승고、혈LDH승고、CRP승고10배이상시수경척패혈증감염；SLE활동여패혈증감염가능상호영향,차병정장자질병활동성수영향경명현.저단백혈증、SSA/SSB항체음성가능시패혈증감염적위험인소,간록규가능유감소패혈증발생적작용.
Objective To investigate the clinical characteristics and predisposing factors of systemic lupus erythematosus (SLE) with sepsis.Methods Twenty-one SLE patients with sepsis admitted to our hospital between 2005-2010 were reviewed in this study.The other 21 inpatients with active SLE in our hospital in the same period were randomly selected as controls.Clinical and laboratory documents of these patients were comparatively analyzed.Results The peak body temperature [ (39.4±0.6) vs (37.2±0.4) ℃,t=13.403,P=0.000],the hyperpyrexia (T≥39 ℃) incidence (71％ vs 5％,X2=19.788,P=0.000),the white blood cell (WBC) counts [(10.2±4.6) vs (6.2±2.5)×109/L,t=3.469,P=0.001)] and neutrophils in the peripheral blood [(8.3±4.5) vs (4.5±2.1)×109/L,t=3.559,P=0.001 ],the C-reactive protein (CRP) level [ (74±59) vs (5±4) mg/L,t=5.398,P=0.000 ] and lactate dehydrogenase (LDH) level [ (444±343) vs ( 225±144) U/L,t=5.398,P=0.000] in the sepsis group were significantly higher than those in the control group.It was noticeable that CRP in the sepsis group was 15 to 20 times higher than that in the control group.The level of serum albumin[ (29±9) vs(35±7) g/L,t=2.688,P=0.011 ],the maintenance dosage of hydroxychloroquine [(0.11±0.08) vs(0.17±0.09) g/d,t=2.331,P=0.025],the frequency of autoantibodies against SSA (38％ vs 71％,X2=4.709,P=0.03) or SSB (0 vs 43％,X2=11.455,P=0.001) in the sepsis group were significantly lower than those in the control group.Correlation analysis showed that,in the sepsis group,the SLE disease activity index (SLEDAI) had significant positive association with SLE duration (r=0.514,P=0.017),the WBC count (r=0.552,P=0.010) and neutrophils count (r=0.545,P=0.011 ),respectively.The neutrophil count correlated positively with the LDH (r=0.482,P=0.032) and CRP (r=0.606,P=0.022).These correlations were not statistically significant in the control group.Conclusion Sepsis should be considered when SLE patients have hyperpyrexia,high levels of WBC and neutrophils,markedly elevated LDH and CRP level,especially when the CRP increases ten times higher than the normal limit.SLE activity and sepsis might affect each other,and this may be more evident in patients with longer disease duration.Hypoalbuminemia and negative autoantibody to SSA or SSB are likely to be the risk factors for SLE to develop sepsis while hydroxcyhloroquine may be protective against sepsis.
