CAJ | 학술논문

目的：探讨SLE合并感染的临床特点，分析导致感染的危险因素。方法收集173例次 SLE 患者的临床资料，根据是否合并感染分为感染组（87例次）和无感染组（86例次）。归纳总结87例次 SLE 合并感染的 SLE 患者发生感染的部位、所感染病原体的种类、治疗方案、时长及结局，比较使用不同种类免疫抑制剂的 SLE 患者感染发生率。采用 Logistic 回归分析 SLE 患者发生感染的危险因素。结果SLE 患者合并感染的发生率为50．7％，53例次（60．9％）的感染发生在病程1年内的初发 SLE 患者中。87例次 SLE 合并感染患者的感染部位以肺部、上呼吸道和尿路为主，病原体以细菌、真菌居多，使用环磷酰胺者的感染发生率明显高于使用吗替麦考酚酯者（P ＜0．01）。84例次行抗感染治疗，58．6％患者的抗感染治疗时间在2周以内，经抗感染治疗后，80例次（92．0％）的感染得以控制，2例（2．3％）死亡，2例转院，3例患者放弃治疗。单因素 Logistic 回归显示，住院时间过长、SLE 疾病活动指数高、使用较大剂量激素及免疫抑制剂治疗、补体（C）3、C4降低、发热、ESR 升高、CRP 升高、血白细胞计数异常以及血清白蛋白过低是 SLE 患者发生感染的危险因素（P 均＜0．05）。多因素 Logistic 回归显示，白细胞计数异常、CRP 升高、C4降低以及住院时间过长是SLE 患者出现感染的独立危险因素（P 均＜0．05）。结论对于 SLE 患者尤其是病程1年以内的初发SLE 患者应高度警惕感染的可能，白细胞计数异常、CRP 升高、C4降低及住院时间过长均会增加感染的风险，应密切留意患者的各项实验室指标，对有感染症状者做到早发现、早治疗，以改善预后。
목적：탐토SLE합병감염적림상특점，분석도치감염적위험인소。방법수집173례차 SLE 환자적림상자료，근거시부합병감염분위감염조（87례차）화무감염조（86례차）。귀납총결87례차 SLE 합병감염적 SLE 환자발생감염적부위、소감염병원체적충류、치료방안、시장급결국，비교사용불동충류면역억제제적 SLE 환자감염발생솔。채용 Logistic 회귀분석 SLE 환자발생감염적위험인소。결과SLE 환자합병감염적발생솔위50．7％，53례차（60．9％）적감염발생재병정1년내적초발 SLE 환자중。87례차 SLE 합병감염환자적감염부위이폐부、상호흡도화뇨로위주，병원체이세균、진균거다，사용배린선알자적감염발생솔명현고우사용마체맥고분지자（P ＜0．01）。84례차행항감염치료，58．6％환자적항감염치료시간재2주이내，경항감염치료후，80례차（92．0％）적감염득이공제，2례（2．3％）사망，2례전원，3례환자방기치료。단인소 Logistic 회귀현시，주원시간과장、SLE 질병활동지수고、사용교대제량격소급면역억제제치료、보체（C）3、C4강저、발열、ESR 승고、CRP 승고、혈백세포계수이상이급혈청백단백과저시 SLE 환자발생감염적위험인소（P 균＜0．05）。다인소 Logistic 회귀현시，백세포계수이상、CRP 승고、C4강저이급주원시간과장시SLE 환자출현감염적독립위험인소（P 균＜0．05）。결론대우 SLE 환자우기시병정1년이내적초발SLE 환자응고도경척감염적가능，백세포계수이상、CRP 승고、C4강저급주원시간과장균회증가감염적풍험，응밀절류의환자적각항실험실지표，대유감염증상자주도조발현、조치료，이개선예후。
Objective To investigate the clinical features of systemic lupus erythematosus (SLE) patients complicated with infection and analyze the risk factors of infection.Methods Clinical data from 173 SLE patients were collected and all participants were divided into the infection (n =87)and non-infection groups (n =86).The site of infection,type of pathogen,treatment method and time,and clinical outcome in 87 SLE patients complicated with infection were retrospectively reviewed.The incidence of infection among pa-tients using different types of immunosuppressant agents was statistically compared.The risk factors of infection in SLE patients were assessed by logistic regression analysis.Results The incidence rate of SLE complicated with infection was 50.7%.Approximately 60.9% (n =53)of these patients were infected within 1-year onset of SLE.The most common infection sites were lung,upper respiratory tract and urinary tract.The most com-mon pathogens included bacteria and fungi.The incidence rate of infection in patients using cyclophosphamide was significantly higher compared with that in those receiving mycophenolate mofetil (P <0.01).Among 84 patients receiving anti-infectious therapy,58.6% of them were treated for <2 weeks.Following anti-infec-tious treatment,80 cases (92.0%)were effectively controlled,two died (2.3%),two were transferred to an-other hospital and three abandoned the therapy.Univariate logistic regression analysis demonstrated that long length of hospital stay,high SLE disease activity index (SLEDAI),use of a large dose of steroid and immuno-suppressant agents,decreased serum level of complement 3 and 4 (C3 and C4),fever,elevated levels of e-rythrocyte sedimentation rate (ESR )and C reactive protein (CRP),abnormal white blood cell count and ex-cessively low level of albumin were the risk factors of SLE complicated with infection (all P <0.05).Multiva-riate logistic regression analysis revealed that abnormal white blood cell count,elevated level of CRP,de-creased level of C4 and excessively long hospital stay were independent risk factors of SLE complicated with in-fection (all P <0.05).Conclusions Patients with primary SLE are prone to be infected by pathogens espe-cially within 1-year onset of SLE.Abnormal white blood cell count,elevated level of CRP,decreased C4 level and excessively long hospital stay tend to enhance the risk of infection.Early diagnosis and treatment should be performed to improve clinical prognosis.