CAJ | 학술논문

目的：探讨系统性红斑狼疮（SLE）患者发生医院感染的临床特点及影响因素，为预防控制医院感染的发生提供参考。方法采取床旁调查和查阅住院病历相结合的方法，根据2001年卫生部《医院感染诊断标准》，将295例SLE患者是否符合医院感染标准分为医院感染组与对照组进行相关因素分析。结果呼吸道及皮肤黏膜是SLE患者最常见的感染部位，其感染率分别为45.6%和18.4%。最常见细菌感染（57.6%），革兰阴性菌、革兰阳性菌分别占38%和19.6%，其中铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌分别占13.0%、8.7%、5.4%、5.4%；其次为疱疹病毒感染（20.7%）；真菌感染占16.3%，其中白色假丝酵母菌占8.7%。使用糖皮质激素治疗后真菌感染率为40.0%，明显高于疱疹病毒及结核感染率，差异有统计学意义（P＜0.05）；低蛋白血症患者普通细菌感染率为63.3%，明显高于真菌、疱疹病毒和结核感染率，差异有统计学意义（P＜0.05）；白细胞减少患者结核感染率为9.1%，与其他组的结核感染率比较，差异无统计学意义（P＞0.05）；从影响医院感染相关因素看， SLE患者住院时间、两个以上器官受损、感染前使用过抗生素治疗、使用糖皮质激素及免疫抑制剂治疗、低蛋白血症和24 h尿蛋白＞3.5 g是医院感染的主要危险因素，其感染率明显高于对照组。结论呼吸道及皮肤黏膜是SLE患者最常见的感染部位，医院感染病原体以革兰阴性菌为主，其次为革兰阳性菌。通过缩短住院时间、有效控制病情、谨慎使用糖皮质激素和免疫抑制剂、合理使用抗生素、防止多器官功能损伤等有可能减少SLE患者医院感染的发生。
목적：탐토계통성홍반랑창（SLE）환자발생의원감염적림상특점급영향인소，위예방공제의원감염적발생제공삼고。방법채취상방조사화사열주원병력상결합적방법，근거2001년위생부《의원감염진단표준》，장295례SLE환자시부부합의원감염표준분위의원감염조여대조조진행상관인소분석。결과호흡도급피부점막시SLE환자최상견적감염부위，기감염솔분별위45.6%화18.4%。최상견세균감염（57.6%），혁란음성균、혁란양성균분별점38%화19.6%，기중동록가단포균、포씨불동간균、대장애희균、금황색포도구균분별점13.0%、8.7%、5.4%、5.4%；기차위포진병독감염（20.7%）；진균감염점16.3%，기중백색가사효모균점8.7%。사용당피질격소치료후진균감염솔위40.0%，명현고우포진병독급결핵감염솔，차이유통계학의의（P＜0.05）；저단백혈증환자보통세균감염솔위63.3%，명현고우진균、포진병독화결핵감염솔，차이유통계학의의（P＜0.05）；백세포감소환자결핵감염솔위9.1%，여기타조적결핵감염솔비교，차이무통계학의의（P＞0.05）；종영향의원감염상관인소간， SLE환자주원시간、량개이상기관수손、감염전사용과항생소치료、사용당피질격소급면역억제제치료、저단백혈증화24 h뇨단백＞3.5 g시의원감염적주요위험인소，기감염솔명현고우대조조。결론호흡도급피부점막시SLE환자최상견적감염부위，의원감염병원체이혁란음성균위주，기차위혁란양성균。통과축단주원시간、유효공제병정、근신사용당피질격소화면역억제제、합리사용항생소、방지다기관공능손상등유가능감소SLE환자의원감염적발생。
Objective To explore the clinical characteristics and inlfuenceing factors of hospital infection occurred in patients with systemic lupus erythematosus (SLE), so as to provide reference for prevention and control of the occurrence of hospital infection. Methods The information was collected by the methods of bedside investigation and hospital records review. According to whether accord with the hospital infection diagnosis standard issued in 2001 by the Ministry of health, total 295 SLE patients were divided into two groups:hospital infection group and the control group, then the hospital infection related factors were analyzed. Results Respiratory tract and skin mucous membrane infection were most common, the infection rate was 45.6%and 18.4%respectively. Bacterial infection was the most common type of infection (57.6%), gram-negative bacteria and gram-positive bacteria accounted for 38%and 19.6%respectively, including pseudomonas aeruginosa(13.0%), Bowman's acinetobacter(8.7%), E. coli(5.4%), Staphylococcus aureus(5.4%);followed by herpes virus infection (20.7%), and fungal infection (16.3%), in which white candida infection more than 8.7%. For the patients accepted glucocorticoid treatment, fungus infection rate was 40.0%, signiifcantly higher than the infection caused by herpes virus and TB (P<0.05);for the patients with hypoalbuminemia, the common bacterial infection rate was 63.3%, signiifcantly higher than that caused by fungi, herpes virus, and TB (P<0.05);for the patients with Leukopenia, TB infection rate was 9.1%, compared with the other groups, there was no statistically signiifcant difference (P>0.05). Length of patient stay in hospital, two or more organs damage, antibiotic used before infection, corticosteroids and immunosuppressant therapy, hypoalbuminemia and 24 h urine protein>3.5 g were the major risk factors that associated with nosocomial infection occurred in hospitalized SLE patients. Conclusions The respiratory tract and skin mucous membrane are the most common sites of infection, SLE patients’ nosocomial infection pathogens is given priority to gram-negative bacteria, followed by gram-positive bacteria. By shortening the length of hospital stay, effectively control of the condition, careful using of glucocorticoid and immunosuppressants, reasonable use of antibiotics and multiple organ damage prevention, etc, could reduce the occurrence of the hospital infection in SLE patients.