Yang Cheng-De, Wang Xiao-Dong, Ye Shuang, Gu Yue-Ying, Bao Chun-De, Wang Yuan, Chen Shun-Le
Department of Rheumatology, Renji Hospital, Medical School of Shanghai JiaoTong University, 145 Shan Dong Zhong Road, 200001, Shanghai, China.
Clin Rheumatol. 2007 Jun;26(6):895-901. doi: 10.1007/s10067-006-0424-x. Epub 2006 Oct 5.
The purpose of this study is to describe the etiology, characteristics and outcomes of central nervous system (CNS) infections in patients with systemic lupus erythematosus (SLE), while also identifying prognostic and risk factors. Thirty-eight SLE patients with CNS infections were identified from review of all charts of patients with SLE hospitalized from January 1995 to June 2005. These patients were divided into 3 groups, i.e., Mycobacterium tuberculosis (TB), non-TB bacterial and fungal infection groups. Of the 38 SLE cases with CNS infections, TB was identified in 19 patients, Listeria monocytogenes in 3 patients, Klebsiella pneumoniae in 1 patient, Staphylococcus aureus in 1 patient, Gram's stain positive bacteria in 1 patient, Cryptococcus neoformans in 12 patients, and Aspergillus fumigatus in 1 patient. The rate of unfavorable outcome in patients with fungal infection was lower than in patients with TB (P=0.028) and non-TB bacterial CNS infections (P=0.046). SLE patients with TB or fungal CNS infections had a more insidious or atypical clinical presentation. Compared to SLE patients without CNS infections, those with CNS infections were more likely to have low serum albumin levels (P=0.048) and have been receiving higher doses of prednisolone at the onset of CNS infection (P=0.015) or higher mean doses of prednisolone within the previous year (P=0.039). In conclusion, low levels of serum albumin and higher doses of received prednisolone are important risk factors for the development of CNS infections in SLE patients.
本研究的目的是描述系统性红斑狼疮（SLE）患者中枢神经系统（CNS）感染的病因、特征及转归，同时确定预后因素和风险因素。通过回顾1995年1月至2005年6月期间住院的所有SLE患者病历，确定了38例患有CNS感染的SLE患者。这些患者被分为3组，即结核分枝杆菌（TB）、非TB细菌和真菌感染组。在38例患有CNS感染的SLE病例中，19例为TB感染，3例为单核细胞增生李斯特菌感染，1例为肺炎克雷伯菌感染，1例为金黄色葡萄球菌感染，1例为革兰氏染色阳性菌感染，12例为新型隐球菌感染，1例为烟曲霉感染。真菌感染患者的不良转归率低于TB感染患者（P = 0.028）和非TB细菌性CNS感染患者（P = 0.046）。患有TB或真菌性CNS感染的SLE患者临床表现更隐匿或不典型。与无CNS感染的SLE患者相比，有CNS感染的患者更可能血清白蛋白水平低（P = 0.048），且在CNS感染发病时接受更高剂量的泼尼松龙（P = 0.015）或在前一年接受更高平均剂量的泼尼松龙（P = 0.039）。总之，血清白蛋白水平低和接受更高剂量的泼尼松龙是SLE患者发生CNS感染的重要风险因素。
