Department of Medicine & Dentistry, University of Alberta, Alberta, Canada.
Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1; Department of Community Health Sciences, University of Calgary, Alberta, Canada.
Semin Arthritis Rheum. 2014 Dec;44(3):325-30. doi: 10.1016/j.semarthrit.2014.06.001. Epub 2014 Jun 26.
Invasive fungal disease (IFD) is a life-threatening complication of systemic lupus erythematosus (SLE) and/or its treatment. We conducted a systematic review to characterize IFD in SLE and identify risk factors and outcomes.
MEDLINE, Embase, and Web of Science were searched up to June 2013 using MeSH terms and keywords pertaining to SLE and IFD. Two independent reviewers selected adult cohort studies and case series/reports on IFD in SLE based on the established classification criteria for both diseases.
In total, 393 cases from 182 studies met the criteria for inclusion. Cryptococcus spp., Aspergillus spp., and Candida spp. were the most common fungal pathogens. Cohorts described IFD in 0.6-3.2% of SLE inpatients and 0.28% of SLE outpatients. IFD occurred at a median of 2 years of disease duration (IQR: 0.5-7.1), and 39% of cases occurred within the first year of SLE. Disease activity and corticosteroid dose >60mg/day emerged as risk factors for IFD. IFD was associated with a mortality rate of 53% (161/316 cases), and worse in the absence of antifungal therapy (n = 43). Overall, 44 cases of IFD were only diagnosed on autopsy.
Our systematic review confirms the severe sequelae of IFD in SLE. Cases occurred in patients with active SLE, who were on high daily corticosteroids doses and at early stages of disease. This highlights the role of poor disease control and a high "net state of immunosuppression" in risk. IFD in SLE should be prospectively examined in the modern era.
侵袭性真菌病（IFD）是系统性红斑狼疮（SLE）及其治疗的一种危及生命的并发症。我们进行了一项系统评价，以描述 SLE 中的 IFD，并确定其危险因素和结局。
使用与 SLE 和 IFD 相关的 MeSH 术语和关键词，在 MEDLINE、Embase 和 Web of Science 上进行了截至 2013 年 6 月的系统性检索。两位独立的审查员根据两种疾病的既定分类标准，选择了成人队列研究和 SLE 中 IFD 的病例系列/报告。
共有 182 项研究的 393 例病例符合纳入标准。隐球菌属、曲霉属和念珠菌属是最常见的真菌病原体。队列研究报告 SLE 住院患者 IFD 的发生率为 0.6%-3.2%，SLE 门诊患者 IFD 的发生率为 0.28%。IFD 发生在疾病病程的中位数为 2 年（IQR：0.5-7.1），39%的病例发生在 SLE 的第一年。疾病活动度和>60mg/天的皮质类固醇剂量是 IFD 的危险因素。IFD 的死亡率为 53%（161/316 例），如果未进行抗真菌治疗（n=43）则更差。总体而言，只有 44 例 IFD 是通过尸检诊断的。
我们的系统评价证实了 SLE 中 IFD 的严重后果。病例发生在活动期 SLE 患者中，他们接受高剂量的每日皮质类固醇治疗，且处于疾病的早期阶段。这突出了疾病控制不佳和高“净免疫抑制状态”在风险中的作用。应在现代时代前瞻性地检查 SLE 中的 IFD。
