Harada Makoto, Ishii Wataru, Masubuchi Takeshi, Ichikawa Tohru, Kobayashi Mamoru
Department of Nephrology, Shinshu University, Matsumoto, JPN.
Department of Rheumatology, Nagano Red Cross Hospital, Nagano, JPN.
Cureus. 2019 Sep 16;11(9):e5676. doi: 10.7759/cureus.5676.
Introduction Infectious complications are the leading cause of death in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). However, the relationship between initial immunosuppressive therapy and the development of infectious complications and the details of infectious complications among patients with AAV are uncertain. We thus aimed to determine the association between initial immunosuppressive therapy and infectious complications. Material and methods Forty-seven patients with newly diagnosed AAV were enrolled in this retrospective observational study (patients with eosinophilic granulomatous polyangiitis were excluded). We statistically determined the association between types of initial immunosuppressive therapy (methylprednisolone pulse and/or cyclophosphamide therapy) and the development of infectious complications. In addition, we investigated the causes and timing of the onset of infectious complications. Results Twenty-one (21; 44.7%) patients required antibiotic, antimycotic, or antiviral therapy because of the development of infectious complications. Multiple logistic regression analyses adjusted for age and sex revealed that methylprednisolone pulse and cyclophosphamide therapy were significantly associated with the development of infectious complications (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.09-21.5, p = 0.038; OR 5.32, 95% CI 1.28-22.2, p = 0.022, respectively). Bacterial pneumonia and sepsis occurred in 10 (47.6%) and 6 (28.6%) patients, respectively. Almost half of these infectious complications, including fungal infection, developed within six months from the start of initial treatment. Conclusion Among patients with AAV, methylprednisolone pulse and cyclophosphamide therapy may increase the risk of developing infectious complications, such as pneumonia and sepsis, including fungal infection, particularly within six months from the initiation of treatment.
引言 感染性并发症是抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者死亡的主要原因。然而，初始免疫抑制治疗与感染性并发症发生之间的关系以及AAV患者感染性并发症的具体情况尚不确定。因此，我们旨在确定初始免疫抑制治疗与感染性并发症之间的关联。
材料与方法 本回顾性观察研究纳入了47例新诊断的AAV患者（排除嗜酸性肉芽肿性多血管炎患者）。我们通过统计学方法确定初始免疫抑制治疗类型（甲泼尼龙冲击治疗和/或环磷酰胺治疗）与感染性并发症发生之间的关联。此外，我们还调查了感染性并发症的病因和发病时间。
结果 21例（21；44.7%）患者因发生感染性并发症而需要使用抗生素、抗真菌药或抗病毒药物治疗。经年龄和性别校正的多因素逻辑回归分析显示，甲泼尼龙冲击治疗和环磷酰胺治疗与感染性并发症的发生显著相关（优势比（OR）分别为4.85，95%置信区间（CI）1.09 - 21.5，p = 0.038；OR 5.32，95%CI 1.28 - 22.2，p = 0.022）。分别有10例（47.6%）和6例（28.6%）患者发生了细菌性肺炎和脓毒症。包括真菌感染在内，几乎一半的这些感染性并发症在初始治疗开始后的6个月内发生。
结论 在AAV患者中，甲泼尼龙冲击治疗和环磷酰胺治疗可能会增加发生感染性并发症的风险，如肺炎和脓毒症，包括真菌感染，尤其是在治疗开始后的6个月内。
