Goldblatt F, Chambers S, Rahman A, Isenberg D A
Centre for Rheumatology, Department of Medicine, University College London Hospital, United Kingdom
Lupus. 2009 Jul;18(8):682-9. doi: 10.1177/0961203308101019.
This retrospective study determined the prevalence and nature of hospitalisations secondary to infection, and examined the mortality from infection in our large British cohort of patients with systemic lupus erythematosus (SLE). Casenote and database information of 104 consecutive patients attending the UCLH specialised SLE clinic were reviewed for the number of hospitalisations due to infection and the clinical and serological features of affected patients. Cohort mortality data were examined to identify deaths secondary to infectious diseases. Infection serious enough to result in hospitalisation occurred in 15% of the patients in the selected sample of our whole cohort. Six patients had more than one admission due to infection, with pneumonia being the most frequent. Typical bacterial pathogens were most commonly identified. A significant association between admissions for infection and nephritis (P < 0.05 by Chi-square) was identified; however, the use of high dose prednisolone or other immunosuppressants did not increase the risk for infection requiring hospitalisation (P > 0.5 by Chi-square) in our study. Between 1978 and 2007, 17 of 67 (25%) deaths in our SLE cohort of 470 patients were because of infection. Patients who died from infectious causes were more likely to have existing or previous renal disease than those who died from non-infectious causes (P < 0.01 by Chi-square). The majority who died from infection were on high dose prednisolone plus at least one other immunosuppressive agent and had serologically active disease. The study highlights the significant problem of infection in British patients with SLE. Early recognition and treatment of infectious diseases in these patients together with considered use of immunosuppressant medications and vaccinations may help to reduce the impact of these complications.
这项回顾性研究确定了继发于感染的住院患病率及性质，并调查了英国一大群系统性红斑狼疮（SLE）患者的感染死亡率。对连续就诊于伦敦大学学院医院（UCLH）专科SLE诊所的104例患者的病历记录和数据库信息进行了回顾，以了解因感染导致的住院次数以及受影响患者的临床和血清学特征。检查队列死亡率数据以确定继发于传染病的死亡情况。在我们整个队列的选定样本中，15%的患者发生了严重到足以导致住院的感染。6例患者因感染多次入院，其中肺炎最为常见。最常鉴定出典型的细菌病原体。确定感染入院与肾炎之间存在显著关联（卡方检验P<0.05）；然而，在我们的研究中，使用高剂量泼尼松龙或其他免疫抑制剂并未增加需要住院治疗的感染风险（卡方检验P>0.5）。在1978年至 2007年期间，我们470例SLE队列中的67例死亡患者中有17例（25%）死于感染。与死于非感染性原因的患者相比，死于感染性原因的患者更有可能患有现有的或既往的肾脏疾病（卡方检验P<0.01）。大多数死于感染的患者正在使用高剂量泼尼松龙加至少一种其他免疫抑制剂，并且患有血清学活动性疾病。该研究突出了英国SLE患者感染这一重大问题。对这些患者的传染病进行早期识别和治疗，同时谨慎使用免疫抑制药物和疫苗接种，可能有助于减少这些并发症的影响。
