1Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital De Cruces, University of the Basque Country, Spain.
Lupus. 2013 Oct;22(12):1286-94. doi: 10.1177/0961203313493032.
Infection is one of the leading causes of morbidity and mortality in systemic lupus erythematosus (SLE). Bacterial infections are most frequent, followed by viral and fungal infections. The impaired cellular and humoral immune functions seen in patients with SLE are predisposing conditions, whilst disease activity, prednisone doses over 7.5-10 mg/day, high doses of methylprednisolone or cyclophosphamide are well-recognised risk factors for infection. The first six months after rituximab treatment and the use of more than three courses are also associated with an increased susceptibility for infection. It has not been established whether belimumab, azathioprine and mycophenolate mofetil increase the risk of serious infections. Most vaccines are effective and safe in SLE patients, although vaccination should be avoided during periods of active disease. Live virus vaccines are contraindicated for immunosuppressed patients. Influenza and pneumococcal vaccines are universally recommended. Tuberculosis prophylaxis should be considered in selected cases. Therefore, it is advisable not to exceed doses of 5 mg/day of prednisone in chronic treatment. Methylprednisolone and cyclophosphamide should be used in low-dose regimens. Antimalarials have a well-known protective role against infection, in addition to other beneficial properties, thus, hydroxychloroquine is recommended for all SLE patients where no contraindication exists.
感染是红斑狼疮（SLE）患者发病率和死亡率的主要原因之一。细菌性感染最为常见，其次是病毒性和真菌性感染。SLE 患者的细胞和体液免疫功能受损是诱发感染的条件，而疾病活动、泼尼松剂量超过 7.5-10mg/天、大剂量甲泼尼龙或环磷酰胺是公认的感染危险因素。利妥昔单抗治疗后的前 6 个月和使用超过 3 个疗程也与感染易感性增加有关。尚不确定贝利尤单抗、硫唑嘌呤和霉酚酸酯是否会增加严重感染的风险。大多数疫苗对 SLE 患者有效且安全，尽管应避免在疾病活动期进行接种。活病毒疫苗不适用于免疫抑制患者。流感和肺炎球菌疫苗普遍推荐使用。应考虑在特定情况下进行结核预防。因此，建议在慢性治疗中不超过 5mg/天的泼尼松剂量。应使用低剂量的甲泼尼龙和环磷酰胺。除了其他有益特性外，抗疟药还具有预防感染的作用，因此，建议所有没有禁忌症的 SLE 患者使用羟氯喹。
