中国系统性红斑狼疮患者的严重肺炎。

Severe pneumonia in Chinese patients with systemic lupus erythematosus.

机构信息

Department of Rheumatology, Union Hospital, Huazhong University of Science and Technology, Wuhan, PR China.

Wuhan Institution for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, PR China.

出版信息

Lupus. 2020 Jun;29(7):735-742. doi: 10.1177/0961203320922609. Epub 2020 May 13.

DOI:10.1177/0961203320922609

PMID:32403979

Abstract

OBJECTIVE

This study aimed to investigate the clinical characteristics and risk factors associated with severe pneumonia in systemic lupus erythematosus (SLE) patients from China.

METHOD

We performed a retrospective study in 112 hospitalized SLE patients who had had pneumonia for 8 years. The primary outcome was severe pneumonia, followed by descriptive analysis, group comparison and bivariate analysis.

RESULTS

A total of 28 SLE patients were diagnosed with severe pneumonia, with a ratio of 5:23 between men and women. The mean age at diagnosis was 44.36 ± 12.389 years. The median disease duration was 72 months, and the median SLE Disease Activity Index 2000 (SLEDAI 2K) score was 8. The haematological system was the most affected, with an incidence of anaemia in 85.7% of cases and thrombocytopenia in 75% of cases, followed by lupus nephritis in 50% of cases and central nervous system involvement in 10.71% of cases. Cultured sputum specimens were positive in 17 (68%) SLE patients with severe pneumonia, of whom nine (36%) were cases of fungal infection, five (20%) were cases of bacterial infection and three (12%) were cases of mixed infection. Using multivariate logistic regression analysis, we concluded that a daily dosage of prednisone (>10 mg; odds ratio (OR) = 3.193, = 0.005), a low percentage of CD4+ T lymphocytes (OR = 0.909, = 0.000), a high SLEDAI 2K score (OR = 1.182, = 0.001) and anaemia (OR = 1.182, = 0.001) were all independent risk factors for pneumonia in SLE patients, while a low percentage of CD4+ T lymphocytes (OR = 0.908, = 0.033), a daily dose of prednisone of >10 mg (OR = 35.67, = 0.001) were independent risk factors for severe pneumonia in SLE patients.

CONCLUSION

Severe pneumonia is not rare in lupus, and is associated with high mortality and poor prognosis. Monitoring CD4+ T-cell counts and giving a small dose of glucocorticoids can reduce the occurrence of severe pneumonia and improve the prognosis of patients with lupus.

摘要

目的

本研究旨在探讨中国系统性红斑狼疮（SLE）患者并发重症肺炎的临床特征及相关危险因素。

方法

我们对 8 年来收治的 112 例并发肺炎的住院 SLE 患者进行了回顾性研究。主要结局为重症肺炎，随后进行描述性分析、组间比较和双变量分析。

结果

共 28 例 SLE 患者被诊断为重症肺炎，男女比例为 5:23。诊断时的平均年龄为 44.36±12.389 岁。中位病程为 72 个月，中位 SLE 疾病活动指数 2000 评分（SLEDAI 2K）为 8。血液系统受累最常见，贫血发生率为 85.7%，血小板减少发生率为 75%，其次为狼疮肾炎（50%）和中枢神经系统受累（10.71%）。28 例重症肺炎患者中培养出痰标本阳性者 17 例（68%），其中真菌感染 9 例（36%）、细菌感染 5 例（20%）、混合感染 3 例（12%）。多因素 logistic 回归分析提示，泼尼松日剂量>10mg（比值比[OR] = 3.193，= 0.005）、CD4+T 淋巴细胞百分比低（OR = 0.909，= 0.000）、SLEDAI 2K 评分高（OR = 1.182，= 0.001）、贫血（OR = 1.182，= 0.001）均为 SLE 患者并发肺炎的独立危险因素，而 CD4+T 淋巴细胞百分比低（OR = 0.908，= 0.033）、泼尼松日剂量>10mg（OR = 35.67，= 0.001）是 SLE 患者并发重症肺炎的独立危险因素。