CAJ | 학술논문

目的了解近年来系统性红斑狼疮(SLE)感染死亡患者的感染部位和感染病原菌.方法回顾分析1986年1月至2011年5月北京协和医院SLE住院死亡病例资料.结果 1986年1月至2011年5月SLE住院死亡患者共252例,其中感染为主要死因的患者共97例,非感染原因为主要死因的患者共155例,感染在同期死亡患者中的比例逐渐上升.1986-1990年、1991-1995年、1996-2000年、2001-2005年和2006-2011年,感染死亡患者占同期死亡患者的比例分别为25.7％,24.1％,31.6％,34.9％和60.3％.在因感染死亡的患者中,肺部感染是主要的感染部位,共63例,占感染死亡患者的65％；回顾2006年1月至2011年5年SLE患者肺部感染患者,其中31例患者的病原菌明确,其中单一病原菌感染共14例,占45％,混合感染共17例,占55％.在单一病原菌感染死亡的患者中,最常见的病原菌是真菌感染,共9例,其中耶氏肺孢子菌肺炎4例,烟曲霉感染2例,镰刀菌属1例,热带念珠菌1例,隐球菌1例；普通细菌感染3例,其中耐甲氧西林金黄色葡萄球菌2例,肺炎克雷伯杆菌1例；死于肺结核2例.在混合感染死亡的患者中,混合细菌感染最常见,共14例,其中常见的混合细菌感染依次为鲍曼不动杆菌、大肠埃希菌、肠球菌、肺炎克雷伯杆菌、绿脓杆菌和阴沟肠杆菌,分别为6例、3例、2例、2例、2例和1例；混合真菌感染的患者共11例,在混合真菌感染的患者中烟曲霉菌6例,热带念珠菌3例,耶氏肺孢子菌3例,黄曲霉2例,土曲霉1例,白色念珠菌2例,光滑念珠菌1例,克柔念珠菌1例；除普通细菌和真菌以外,巨细胞病毒感染也是混合感染中常见的病原菌,共5例.结论感染已成为SLE的最主要死因；肺部感染是最常见的感染部位,混合感染常见,烟曲霉菌、耶氏肺孢子菌、鲍曼不动杆菌和巨细胞病毒感染是以感染为主要死因患者的常见病原体.
목적 료해근년래계통성홍반랑창(SLE)감염사망환자적감염부위화감염병원균.방법 회고분석1986년1월지2011년5월북경협화의원SLE주원사망병례자료.결과 1986년1월지2011년5월SLE주원사망환자공252례,기중감염위주요사인적환자공97례,비감염원인위주요사인적환자공155례,감염재동기사망환자중적비례축점상승.1986-1990년、1991-1995년、1996-2000년、2001-2005년화2006-2011년,감염사망환자점동기사망환자적비례분별위25.7％,24.1％,31.6％,34.9％화60.3％.재인감염사망적환자중,폐부감염시주요적감염부위,공63례,점감염사망환자적65％；회고2006년1월지2011년5년SLE환자폐부감염환자,기중31례환자적병원균명학,기중단일병원균감염공14례,점45％,혼합감염공17례,점55％.재단일병원균감염사망적환자중,최상견적병원균시진균감염,공9례,기중야씨폐포자균폐염4례,연곡매감염2례,렴도균속1례,열대념주균1례,은구균1례；보통세균감염3례,기중내갑양서림금황색포도구균2례,폐염극뢰백간균1례；사우폐결핵2례.재혼합감염사망적환자중,혼합세균감염최상견,공14례,기중상견적혼합세균감염의차위포만불동간균、대장애희균、장구균、폐염극뢰백간균、록농간균화음구장간균,분별위6례、3례、2례、2례、2례화1례；혼합진균감염적환자공11례,재혼합진균감염적환자중연곡매균6례,열대념주균3례,야씨폐포자균3례,황곡매2례,토곡매1례,백색념주균2례,광활념주균1례,극유념주균1례；제보통세균화진균이외,거세포병독감염야시혼합감염중상견적병원균,공5례.결론 감염이성위SLE적최주요사인；폐부감염시최상견적감염부위,혼합감염상견,연곡매균、야씨폐포자균、포만불동간균화거세포병독감염시이감염위주요사인환자적상견병원체.
Objective To investigate the location and the pathogens of systemic lupus erythematosus (SLE) patients who died from infection.Methods Dead cases of hospitalized SLE patients in Peking Union Medical Hospital from January 1986 to May 2011were retrospectively analyzed.Results Severe infection was an important cause of mortality in patients with SLE.There were 252 dead cases of SLE in total from 1986 to 2011,in which 97 cases died from severe infection.The proportion of patients died from infection was gradually increased during the past 26 years,which was 25.7％,24.1％,31.6％,34.9％ and 60.3％ in 1986-1990,1991-1995,1996-2000,2001-2005 and 2006-2011respectively.Lung was the most common site of infec-t ion,accounting for 65％ of all dead cases.Among the 31cases with identified microorganism,14 patients had single microorganism infection and 17 patients had mixed infections.In the single microorganism infection patients,fungal infection contributed to the cause of death in 9 out of 14 (64％) patients,of which 4,2,1,1,and 1 cases were infected with Pneumocystis carinii, Aspergillus fumigates,Fusarium,Candida tropicalis and Cryptococcus respectively.There were 3 cases of bacteria infection,including 2 cases with Methicillinresistant staphylococcus,aureus and 1case with Klebsiella pneumoniae infection.Two patients died from pulmonary tuberculosis.In 17 patients with mixed infection cases, 14 deaths were caused by bacteria infection,including Acinetobacter baumannii, Eschefichia coli, Enterococcus, Klebsiella pneumoniae,Pseudomonas aeruginosa and Enterobacter cloacae.Eleven patients died from mixed fungus infection,including 6 cases of Aspergillus fumigates,3 cases of Candida tropicalis,3 cases of Pneumocystis carinii,2 cases of Aspergillus flavus,1 case of Soil Aspergillus,2 cases of Candida albicans,1 case of Candida glabrata and Candida Krusei.In addition to bacteria and fungi infection,cytomegalovirus infection occurred frequently in SLE death cases.Conclusions Severe infection has been the most frequent cause of death in SLE patients,in which lung infection is the leading cause.Pneumocystis carinii,Aspergillus fumigates,Acinetobacter baumannii and cytomegalovirus are the major pathogens that cause death in SLE patients.