CAJ | 학술논문

目的研究弥漫性结缔组织病(DCTD)住院患者合并侵袭性真菌感染的临床特征、危险因素及预后影响因素.方法回顾性收集2007年1月至2011年1月,上海仁济医院风湿科住院的DCTD合并侵袭性真菌感染患者33例.对照患者来自同期住院的67例其他感染患者,包括活动性结核感染患者33例和其他细菌感染患者34例.同时,历史对照为2002年1月至2006年12月11例系统性红斑狼疮(SLE)合并侵袭性真菌感染的住院患者.按数据分布类型选用相应的统计方法:单因素方差分析,秩和检验x2检验,确切概率法；多元分析采用Logistic逐步回归方法和Log-rank生存分析.结果 DCTD患者中发生侵袭性真菌感染,主要的基础疾病为SLE(18例.55％),系统性血管炎(4例,12％)和炎症性肌病(4例,12％).最常见的病原致病菌为念珠菌属(13例.39％),隐球菌属(10例,30％)和曲霉菌属(3例,9％).感染部位则包括肺部(19例,58％),中枢神经系统(9例,27％)和血液播散型(4例,12％).6例(18％)患者死于侵袭性真菌感染.相对于其他感染患者,侵袭性真菌感染患者的基础疾病的病程较短、感染前暴露的激素量较多、肝酶增高、空腹血糖增高及C反应蛋白水平增高.历史生存对照分析,发现近几年的SLE合并侵袭性真菌感染患者的短期生存率提高(历史组和近期组分别为64％和83％).结论熟悉DCTD患者并发侵袭性真菌感染的疾病谱及相关的危险因素将有助于临床医生及时恰当地干预；侵袭性真菌感染认识的进步和抗真菌药物的进展最终有望改善该类患者的预后.
목적 연구미만성결체조직병(DCTD)주원환자합병침습성진균감염적림상특정、위험인소급예후영향인소.방법 회고성수집2007년1월지2011년1월,상해인제의원풍습과주원적DCTD합병침습성진균감염환자33례.대조환자래자동기주원적67례기타감염환자,포괄활동성결핵감염환자33례화기타세균감염환자34례.동시,역사대조위2002년1월지2006년12월11례계통성홍반랑창(SLE)합병침습성진균감염적주원환자.안수거분포류형선용상응적통계방법:단인소방차분석,질화검험x2검험,학절개솔법；다원분석채용Logistic축보회귀방법화Log-rank생존분석.결과 DCTD환자중발생침습성진균감염,주요적기출질병위SLE(18례.55％),계통성혈관염(4례,12％)화염증성기병(4례,12％).최상견적병원치병균위념주균속(13례.39％),은구균속(10례,30％)화곡매균속(3례,9％).감염부위칙포괄폐부(19례,58％),중추신경계통(9례,27％)화혈액파산형(4례,12％).6례(18％)환자사우침습성진균감염.상대우기타감염환자,침습성진균감염환자적기출질병적병정교단、감염전폭로적격소량교다、간매증고、공복혈당증고급C반응단백수평증고.역사생존대조분석,발현근궤년적SLE합병침습성진균감염환자적단기생존솔제고(역사조화근기조분별위64％화83％).결론 숙실DCTD환자병발침습성진균감염적질병보급상관적위험인소장유조우림상의생급시흡당지간예；침습성진균감염인식적진보화항진균약물적진전최종유망개선해류환자적예후.
Objective Invasive fungal infection (IFI) can be a lethal complication in patients with diffuse connective tissue diseases (DCTD).The aim of this study was to determine the characteristics of hospitalized DCTD patients with IFI,and identify the risk factors.Methods Data from 33 DCTD in patients with IFI at Shanghai Renji Hospital between Jan 2007 and Jan 2011 were collected retrospectively.DCTD patients with either active M.tuberculosis (n=33) or other bacterial infections (n=34) at the same period were taken as controls.Systemic lupus erythematosus (SLE) inpatients with IFI (n=11 ) from Jan 2002 to Dec 2006 were also considered as a historical control group.The method of univariate analysis of data depended on the data distribution type.Variables that suggested association in the univariate analysis P＜0.1 were entered into a stepwise logistic regression model.Results The leading underlying diseases of DCTD with IFI were SLE (n=18,55％),systemic vasculitis (n=4,12％),and inflammatory myopathy (n=4,12％).The most frequent pathogen was Candida spp (n=13,39％ ),followed by Cryptococcus neoformans (n=10,30％ ),and Aspergillus (n=3,9％).The infection locations included lung (n=19,58％),central nervous system (n=9,27％ ),and disseminated IFI (n=4,12％ ).Six patients (18％) died from IFI.Compared with non-IFI infections,patients with IFI infection had a shorter duration of underlying disease and were exposed to high doses of prednisolone prior to infection.More patients with IFI infection had elevated alanine aminotransferase,higher fasting glucose and lower C-reactive protein levels when compared to patients with non-IFI infections.Compared with the two historical SLE-IFI groups, the short-term survival improved in lupus patients complicated with IFI infection over time (64％ vs 83％).Conclusion Understanding disease spectrums and risk factors of IFI in DCTD,along with advances in antifungal treatment,will help clinicians to manage those patients with invasive fungal infection effectively to achieve favourable prognosis.