Massardo L, Martínez M E, Baro M, Figueroa F, Rivero S, Jacobelli S
Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago.
Rev Med Chil. 1991 Oct;119(10):1115-22.
In this review of 159 pts with systemic lupus erythematosus (SLE) followed for 18 years, 78 pts had major infections (20/100 pt-years). Patients with infection had a higher incidence of proteinuria, central nervous system involvement, the use of methylprednisolone boluses and mortality rate. Infection was independent of the amount of steroids and immunosuppressor drugs used. Microorganisms were isolated in 77% of the cases, gram negative enterobacteria were the most common isolates. 30% of the pts had pulmonary infection; and 84% of the infections happened during steroid therapy. Immunosuppression was associated to repeated infections. The 19 pts with fatal infections had a higher frequency of pneumonia and septicemia, and received high doses of steroids (> or = 40 mg). No relation to immunosuppression was found in this group. In 26% opportunistic microorganisms were isolated in association to the use of high doses of steroids. Even if survival of SLE has improved in the last 40 years, infections are still an important cause of mortality, most of them related to aggressive steroid therapy.
在这项对159例系统性红斑狼疮（SLE）患者进行了18年随访的研究中，78例患者发生了严重感染（每100患者年有20例）。感染患者蛋白尿、中枢神经系统受累、使用甲泼尼龙冲击治疗的发生率及死亡率更高。感染与所用类固醇和免疫抑制剂的剂量无关。77%的病例分离出了微生物，革兰氏阴性肠道杆菌是最常见的分离菌。30%的患者发生肺部感染；84%的感染发生在类固醇治疗期间。免疫抑制与反复感染有关。19例发生致命感染的患者肺炎和败血症的发生率更高，且接受了高剂量类固醇（≥40mg）治疗。该组未发现与免疫抑制有关。26%的病例中分离出机会性微生物与使用高剂量类固醇有关。尽管在过去40年中SLE患者的生存率有所提高，但感染仍是一个重要的死亡原因，其中大多数与积极的类固醇治疗有关。
