Wang Kuo-Cheng, Liu Peng-Huei, Yu Kuang-Hui, Weng Yi-Ming, Ng Chip-Jin, Chiu Te-Fa, Chen Shou-Yen
Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linko, Taiwan.
Immunol Lett. 2017 May;185:84-89. doi: 10.1016/j.imlet.2017.03.008. Epub 2017 Mar 9.
C-reactive protein (CRP), a marker for inflammation, indicates bacterial infection in systemic lupus erythematosus (SLE) when markedly elevated. Our study investigated the association of regular corticosteroid or immunosuppressant use with initial CRP level in febrile SLE patients with bacterial infection.
This retrospective cohort study included adult SLE patients (18 years of age or older) who presented with fever at the emergency department from January 2008 to December 2012. Data were retrieved from our institutional database.
CRP levels in the total 193 patient database were significantly increased in the bacterial infection group compared to the no infection and non-bacterial infection groups. Seventy-eight (86.7%) of the 90 patients in the bacterial infection group took regular corticosteroids (mean equivalent dose of prednisolone 0.33±0.26mg/kg/day) and 55 (61.1%) used immunosuppressants. Mean CRP level in the bacterial infection group was 97.8mg/L. CRP level was lower in patients using corticosteroids, but the difference between users and nonusers of corticosteroids was not statistically significant (p=0.367). The difference in CRP level between immunosuppressant and non-immunosuppressant users was also not significant (p=0.599). The Spearman test found no correlation between corticosteroid dosage and CRP level (p=0.911).
Initial CRP level was not significantly associated with regular corticosteroid or immunosuppressant use in SLEs patients during a bacterial infection episode, and CRP level was not dose-dependently related to daily corticosteroid use. An elevated CRP level might be an appropriate marker for bacterial infection at the emergency department for febrile SLE patients.
C反应蛋白（CRP）作为一种炎症标志物，在系统性红斑狼疮（SLE）中显著升高时提示细菌感染。我们的研究调查了发热的SLE细菌感染患者常规使用糖皮质激素或免疫抑制剂与初始CRP水平之间的关联。
这项回顾性队列研究纳入了2008年1月至2012年12月在急诊科就诊的成年SLE患者（18岁及以上）。数据从我们机构的数据库中获取。
与无感染组和非细菌感染组相比，193例患者数据库中细菌感染组的CRP水平显著升高。细菌感染组90例患者中有78例（86.7%）常规服用糖皮质激素（泼尼松龙平均等效剂量0.33±0.26mg/kg/天），55例（61.1%）使用免疫抑制剂。细菌感染组的平均CRP水平为97.8mg/L。使用糖皮质激素的患者CRP水平较低，但糖皮质激素使用者与非使用者之间的差异无统计学意义（p=0.367）。免疫抑制剂使用者与非使用者之间的CRP水平差异也不显著（p=0.599）。Spearman检验发现糖皮质激素剂量与CRP水平之间无相关性（p=0.911）。
在SLE患者细菌感染发作期间，初始CRP水平与常规使用糖皮质激素或免疫抑制剂无显著关联，且CRP水平与每日糖皮质激素使用不存在剂量依赖性关系。对于发热的SLE患者，急诊科CRP水平升高可能是细菌感染的合适标志物。
