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系统性红斑狼疮中的感染相关发作

Infection-Associated Flares in Systemic Lupus Erythematosus.

作者信息

Ramirez Giuseppe A, Calabrese Chiara, Secci Marta, Moroni Luca, Gallina Gabriele D, Benanti Giovanni, Bozzolo Enrica P, Matucci-Cerinic Marco, Dagna Lorenzo

机构信息

Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.

Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy.

出版信息

Pathogens. 2024 Oct 26;13(11):934. doi: 10.3390/pathogens13110934.

Abstract

Systemic lupus erythematosus (SLE) is characterised by generalised immune dysfunction, including infection susceptibility. Infection-associated flares (IAFs) are common and might rapidly self-resolve, paralleling infection resolution, but their specific clinical phenotype is poorly understood. Therefore, we screened 2039 consecutive visits and identified 134 flares, defined as a loss of the lupus low disease activity state (LLDAS), from 1089 visits at risk spanning over multiple follow-up years, yielding an average yearly LLDAS deterioration rate of 17%. Thirty-eight IAFs were isolated from the total flares and were mostly related to bacterial and herpesvirus infections. When compared to other flares (OFs; n = 98), IAFs showed no milder patterns of organ involvement and similar rates of long-term damage accrual, as estimated by conventional clinimetrics. Arthritis in IAFs was more severe than that in OFs [median (interquartile range) DAS-28 2.6 (2.3-4.1) vs. 2.0 (1.6-2.7); = 0.02]. Viral IAFs were characterised by atypically lower levels of anti-DNA antibodies ( < 0.001) and possibly abnormally high complement levels when compared to flares of different origin. These data suggest that IAFs are of comparable or even higher severity than OFs and may subtend distinct pathophysiological mechanisms that are poorly tackled by current treatments. Further research is needed to confirm these data.

摘要

系统性红斑狼疮(SLE)的特征是全身性免疫功能障碍,包括易感染。感染相关的病情活动(IAF)很常见,可能会随着感染的消退而迅速自行缓解,但其具体的临床表型尚不清楚。因此,我们筛选了2039次连续就诊病例,从1089次有风险的就诊病例中确定了134次病情活动,这些病情活动被定义为狼疮低疾病活动状态(LLDAS)的丧失,随访多年,得出LLDAS的年平均恶化率为17%。在所有病情活动中分离出38次IAF,大多与细菌和疱疹病毒感染有关。与其他病情活动(OF;n = 98)相比,IAF没有显示出较轻的器官受累模式,根据传统临床计量学估计,其长期损害累积率相似。IAF中的关节炎比OF中的更严重[中位数(四分位间距)DAS-28 2.6(2.3-4.1)对2.0(1.6-2.7);P = 0.02]。与不同来源的病情活动相比,病毒引起的IAF的特点是抗DNA抗体水平异常降低(P < 0.001),补体水平可能异常升高。这些数据表明,IAF的严重程度与OF相当甚至更高,可能存在不同的病理生理机制,目前的治疗方法对此处理不佳。需要进一步的研究来证实这些数据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e4e7/11597141/aef1cc2ea761/pathogens-13-00934-g001.jpg

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