Kang Insoo, Park Sung Hwan
Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Curr Opin Rheumatol. 2003 Sep;15(5):528-34. doi: 10.1097/00002281-200309000-00002.
Immunosuppressive drugs have become the gold standard for the treatment of major organ involvement in systemic lupus erythematosus. The use of immunosuppressive therapy in systemic lupus erythematosus carries significant risks for infection. This article reviews infectious complications in systemic lupus erythematosus, focusing on effects of immunosuppressive therapy. Patients with systemic lupus erythematosus appear to carry an intrinsically increased risk for infection. Recent studies support this notion further by showing increased risk for serious infections in patients with systemic lupus erythematosus who had mannose-binding lectin deficiency associated with homozygous mannose-binding lectin variant alleles. Patients with systemic lupus erythematosus who were homozygous for mannose-binding lectin variant alleles had a fourfold increase in the incidence of infections, requiring hospitalization. In terms of extrinsic risk factors for infection, use of steroids and cyclophosphamide are the strongest risk factors. The effect of these drugs on infection is also dose dependent. The incidence of infectious complications in patients treated with mycophenolate mofetil, a newly used immunosuppressive drug in systemic lupus erythematosus, appears less frequent compared with cyclophosphamide. Herpes zoster is still the most common viral infection in patients with systemic lupus erythematosus treated with cyclophosphamide and mycophenolate mofetil. Overall data indicate that patients with systemic lupus erythematosus may have intrinsically increased risks for infection that are augmented by immunosuppressive therapies. Cyclophosphamide, in particular in combination with high-dose glucocorticoids, has the strongest effect in suppressing the immune responses against microorganisms. Careful monitoring of infectious complications is warranted in patients with systemic lupus erythematosus receiving immunosuppressive therapies, in particular those on high-dose glucocorticoids and cytotoxic drugs.
免疫抑制药物已成为治疗系统性红斑狼疮主要器官受累的金标准。在系统性红斑狼疮中使用免疫抑制疗法会带来显著的感染风险。本文综述了系统性红斑狼疮的感染并发症，重点关注免疫抑制疗法的影响。系统性红斑狼疮患者似乎本身就存在感染风险增加的情况。最近的研究通过显示患有与纯合甘露糖结合凝集素变异等位基因相关的甘露糖结合凝集素缺乏症的系统性红斑狼疮患者发生严重感染的风险增加，进一步支持了这一观点。纯合甘露糖结合凝集素变异等位基因的系统性红斑狼疮患者感染发生率增加了四倍，需要住院治疗。就感染的外在风险因素而言，使用类固醇和环磷酰胺是最强的风险因素。这些药物对感染的影响也呈剂量依赖性。与环磷酰胺相比，霉酚酸酯（一种新用于系统性红斑狼疮的免疫抑制药物）治疗的患者感染并发症的发生率似乎较低。带状疱疹仍然是接受环磷酰胺和霉酚酸酯治疗的系统性红斑狼疮患者中最常见的病毒感染。总体数据表明，系统性红斑狼疮患者可能本身就存在感染风险增加的情况，而免疫抑制疗法会进一步加剧这种风险。环磷酰胺，特别是与高剂量糖皮质激素联合使用时，在抑制针对微生物的免疫反应方面效果最强。对于接受免疫抑制疗法的系统性红斑狼疮患者，特别是那些使用高剂量糖皮质激素和细胞毒性药物的患者，有必要仔细监测感染并发症。
