Laoprasopwattana Kamolwish, Dissaneewate Pornsak, Vachvanichsanong Prayong
Department of Pediatrics, Prince of Songkla University, Songkhla, Thailand.
Pediatr Nephrol. 2009 Jul;24(7):1337-43. doi: 10.1007/s00467-009-1152-7. Epub 2009 Mar 12.
A knowledge of the causes and risk factors of fatal infection in childhood lupus nephritis (LN) patients treated with intravenous cyclophosphamide (IVCY) is important to enable optimal treatment. During an 11-year period (1996-2007), severe infection cases occurred in 31/84 (36.9%) patients with 64 infection episodes in our central referral institution in southern Thailand. Fatal infections occurred in 13/31 (41.9%) patients, most (11/13, 84.6%) during the first infective episode. The major causative organisms of the fatal infections were fungus and Gram-negative bacilli. Fatal infections were more likely to occur in patients with a prior history of treatment with pulse methylprednisolone and in patients with more active LN, as evidenced by the higher proteinuria and serum creatinine levels and lower hemoglobin and lymphocyte counts in this group than in patients with non-fatal infections. Multivariate analysis indicated that factors associated with fatal infection were prior treatment with pulse methylprednisolone [odds ratio (OR) 11.2, 95% confidence interval (CI) 1.9-61.0], renal failure (OR 5.9, 95% CI 1.0-34.8), and fungal infection (OR 23.9, 95% CI 1.9-298.2). Cases of active LN treated with IVCY and pulse methylprednisolone who later develop severe infection that fails to respond to antibiotics should be carefully investigated for fungal infection.
了解接受静脉环磷酰胺（IVCY）治疗的儿童狼疮性肾炎（LN）患者发生致命感染的原因和风险因素，对于实现最佳治疗至关重要。在11年期间（1996 - 2007年），泰国南部我们的中央转诊机构中，84例患者中有31例（36.9%）发生了严重感染，共64次感染发作。13例（41.9%）患者发生了致命感染，其中大多数（11/13，84.6%）发生在首次感染发作期间。致命感染的主要病原体是真菌和革兰氏阴性杆菌。与非致命感染患者相比，有脉冲甲基强的松龙治疗史的患者以及LN更活跃的患者更容易发生致命感染，这组患者的蛋白尿和血清肌酐水平更高，血红蛋白和淋巴细胞计数更低。多因素分析表明，与致命感染相关的因素是脉冲甲基强的松龙的既往治疗[比值比（OR）11.2，95%置信区间（CI）1.9 - 61.0]、肾衰竭（OR 5.9，95% CI 1.0 - 34.8）和真菌感染（OR 23.9，95% CI 1.9 - 298.2）。对于接受IVCY和脉冲甲基强的松龙治疗的活跃LN病例，如果后来发生严重感染且对抗生素无反应，应仔细调查是否存在真菌感染。
