Matsumoto Yoshinori, Sada Ken-ei, Takano Mariko, Toyota Noriko, Yamanaka Ryutaro, Sugiyama Koichi, Wakabayashi Hiroshi, Kawabata Tomoko, Otsuka Fumio, Makino Hirofumi
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Acta Med Okayama. 2011 Oct;65(5):329-34. doi: 10.18926/AMO/47015.
It is well known that infection is one of the major causes of morbidity and mortality in rheumatic disease patients treated with high-dose glucocorticoids, especially in the early phase after achievement of disease remission. The aim of this study was to identify the risk factors for infection, with a focus on the dose of glucocorticoids administered, following the achievement of disease remission in rheumatic diseases patients. We retrospectively analyzed the medical records of rheumatic disease patients who had been treated with glucocorticoids. The primary endpoint was the incidence rate of infection during a period from 1 to 2 months after the commencement of treatment. From April 2006 to March 2010, 19 of 92 patients suffered from infection during the observation period. Age ≧ 65 yrs, presence of interstitial pneumonia, diagnosis of systemic vasculitis and serum creatinine level ≧ 2.0 mg/dl were found to be univariate predictors for infection. However, only the presence of interstitial pneumonia was an independent risk factor for infection (HR＝4.50, 95%CI＝1.65 to 14.44) by the Cox proportional hazard model. Even after achievement of clinical remission, careful observation is needed for patients with interstitial pneumonia, more so than for those receiving high-dose glucocorticoids.
众所周知，感染是接受大剂量糖皮质激素治疗的风湿性疾病患者发病和死亡的主要原因之一，尤其是在疾病缓解后的早期阶段。本研究的目的是确定感染的危险因素，重点关注风湿性疾病患者疾病缓解后给予的糖皮质激素剂量。我们回顾性分析了接受糖皮质激素治疗的风湿性疾病患者的病历。主要终点是治疗开始后1至2个月期间的感染发生率。2006年4月至2010年3月，92例患者中有19例在观察期内发生感染。年龄≧65岁、存在间质性肺炎、诊断为系统性血管炎和血清肌酐水平≧2.0mg/dl被发现是感染的单因素预测指标。然而，根据Cox比例风险模型，只有间质性肺炎的存在是感染的独立危险因素（HR＝4.50，95%CI＝1.65至14.44）。即使在临床缓解后，与接受大剂量糖皮质激素治疗的患者相比，间质性肺炎患者更需要密切观察。
