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目的总结系统性红斑狼疮(SLE)患者合并感染的特点及其影响因素。方法对2011年7月至2013年5月收治的728例SLE患者的临床资料进行回顾性分析,统计患者的感染部位、病原菌,对患者在病情活动度、合并狼疮性肾炎、外周血白细胞减少、补体C3及C4下降、血沉及C反应蛋白(CRP)水平、激素和免疫抑制剂运用、住院时间、住院费用及死亡情况等多种因素下进行感染和非感染的分组分析。结果 728例SLE患者合并感染的发生率为34.48%,病原体多为细菌,呼吸道感染居首位;不活动组及轻、中、重度活动组间感染率差异无统计学意义(P>0.05)。感染组合并狼疮性肾炎发生率高于非感染组(P<0.05);CRP升高率及CRP水平均高于非感染组(P<0.05,P<0.01)。外周白细胞降低率、补体C3下降率、C4下降率、ESR升高率及ESR水平,在感染组与非感染组间比较差异均无统计学意义(P均>0.05)。感染率在单用糖皮质激素(30.13%)及联用免疫抑制剂1种(38.66%)、2种(36.63%)、3种患者(64.29%)中差异有统计学意义(P<0.05)。感染组住院时间、住院费用均高于非感染组(P均<0.01),两组病死率比较差异无统计学意义(P>0.05)。结论 SLE患者感染发生率高,多为呼吸系统的细菌感染;有狼疮性肾炎者更易发生感染,但疾病的活动度、补体水平与感染发生率无明显关系,免疫抑制剂的运用对感染有一定的影响;合并感染延长住院时间,增加住院费用,但对病死率无明显影响。
Objective To summarize the characteristics and influencing factors of co-infection in patients with systemic lupus erythematosus (SLE). Methods The clinical data of 728 patients with SLE admitted from July 2011 to May 2013 were analyzed retrospectively. The infection sites and pathogenic bacteria of patients were analyzed retrospectively. The changes of disease activity, lupus nephritis, peripheral leukopenia, Complement C3 and C4 decline, ESR and CRP level, the use of hormones and immunosuppressive agents, hospital stay, hospitalization costs and death and other factors under the infection and non-infection group analysis. Results The incidence of infection in 728 SLE patients was 34.48%. Most of the pathogens were bacteria and respiratory tract infection was the highest. There was no significant difference in infection rate between inactive group and mild, moderate and severe active groups (P> 0.05). The incidence of infection combined with lupus nephritis was higher than that of non-infected group (P <0.05). The rates of CRP and CRP were higher in non-infected group than in non-infected group (P <0.05, P <0.01). Peripheral leukopenia, C3 declining rate, C4 decreasing rate, ESR increasing rate and ESR level had no significant difference between infected group and non-infected group (all P> 0.05). The infection rate was significantly different between single glucocorticoid (30.13%) and combination immunosuppressant (38.66%), two kinds (36.63%) and three kinds of patients (64.29%) (P <0.05) . Infection group hospitalization time, hospitalization costs were higher than non-infected group (P <0.01), no significant difference in mortality between the two groups (P> 0.05). Conclusions The incidence of SLE patients is high, most of which are bacterial infections of the respiratory system. Patients with lupus nephritis are more likely to have infection, but disease activity and complement levels have no significant relationship with the incidence of infection. The use of immunosuppressive agents has certain effect on infection The impact of co-infection to prolong the hospital stay, increase hospital costs, but no significant impact on mortality.