系统性红斑狼疮患者的肺炎球菌感染。

Pneumococcal infection in patients with systemic lupus erythematosus.

机构信息

Département de médecine interne, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75018 Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, 75018 Paris, France.

Université Paris Diderot, PRES Sorbonne Paris Cité, 75018 Paris, France; Département d'épidémiologie, biostatistiques et recherche clinique, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75018 Paris, France.

出版信息

Joint Bone Spine. 2018 May;85(3):333-336. doi: 10.1016/j.jbspin.2017.05.012. Epub 2017 May 18.

DOI:10.1016/j.jbspin.2017.05.012

PMID:28529115

Abstract

OBJECTIVE

Our study aimed to analyze the risk factors associated with the occurrence and severity of pneumococcal infection (PI) in systemic lupus erythematosus (SLE) patients.

METHODS

Medical records of all SLE patients admitted in our department from January 2005 to December 2014 were retrospectively reviewed. SLE patients were separated in 2 groups according to whether they had PI or not. Medical records of all consecutive patients (with and without SLE) admitted in our department for PI over the same period of time were also reviewed. Clinical characteristics associated with PI occurrence and severity were analyzed in SLE patients.

RESULTS

One hundred and ninety SLE patients (42.2+14.9 years; 87.4% females) were hospitalized over a 10-year period. PI was the reason for admission in 6 (3.2%) patients, including 5 cases of invasive infection. With a follow-up of 2112.8 patient-years for the total cohort, incidence of invasive PI in SLE was of 236/100,000 patient-years. PI occurred at a younger age (43.5+14.9 versus 65.3+18.7 years, P<0.01) and were more severe, with a higher frequency of invasive infection (P<0.001) and higher need for ICU admission (P<0.05) in SLE as compared to non SLE patients. Risk factors associated with PI in SLE patients were a serum gammaglobulin level<5g/L (P<0.01) and a past history of lupus nephritis (P<0.05), only. Steroids (P<0.001) and immunosuppressive drugs (P<0.05) were associated with infection severity.

CONCLUSION

SLE is a disease of high susceptibility for invasive pneumococcal infections. Our study points to the need for vaccination against Streptococcus pneumoniae in SLE.

摘要

目的

本研究旨在分析系统性红斑狼疮（SLE）患者发生和严重程度的肺炎球菌感染（PI）的相关危险因素。

方法

回顾性分析 2005 年 1 月至 2014 年 12 月期间我科收治的所有 SLE 患者的病历。根据患者是否发生 PI 将 SLE 患者分为两组。同时回顾同期我科收治的所有连续（SLE 患者和非 SLE 患者）PI 患者的病历。分析 SLE 患者发生 PI 的临床特征及严重程度。

结果

10 年间共收治 190 例 SLE 患者（42.2+14.9 岁；87.4%为女性）。6 例（3.2%）患者因 PI 住院，其中 5 例为侵袭性感染。在总队列中，2112.8 人年的随访中，SLE 患者侵袭性 PI 的发生率为 236/100,000 人年。与非 SLE 患者相比，SLE 患者发生 PI 的年龄更小（43.5+14.9 岁 vs. 65.3+18.7 岁，P<0.01），病情更严重，侵袭性感染发生率更高（P<0.001），需要入住 ICU 的比例更高（P<0.05）。与 SLE 患者发生 PI 相关的危险因素是血清球蛋白水平<5g/L（P<0.01）和狼疮肾炎史（P<0.05）。仅类固醇（P<0.001）和免疫抑制剂（P<0.05）与感染严重程度相关。