Borrelli R, Nicola S, Corradi F, Badiu I, Lo Sardo L, Rashidy N, Quinternetto A, Mazzola M, Meli F, Saracco E, Vitali I, Negrini S, Brussino L
Allergy and Immunology Unit, Department of Medical Science, University of Turin, Mauriziano Hospital, 10128 Turin, Italy.
Bioengineering (Basel). 2025 Jan 13;12(1):59. doi: 10.3390/bioengineering12010059.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that exhibits considerable diversity in terms of both clinical and immunological manifestations. Since its female-to-male ratio is around 9:1, it is well recognized that systemic lupus erythematosus mostly affects women, especially those of childbearing age. There is a greater susceptibility to infections in adult patients with systemic lupus erythematosus (SLE) compared to the general population. However, only a small number of studies have attempted to analyze this risk using real-life data, and even fewer have successfully assessed the influence of sex. A retrospective study was conducted, enrolling patients and dividing them into two groups based on their biological sex. Infectious episodes were identified from medical records and categorized by severity. Patients were stratified according to disease duration and treatment received. Logistic regression analysis was used to calculate the odds ratio (OR), with a 95% confidence interval (CI) for the assessment of risk factors. Multivariable logistic regression was performed to adjust for potential confounders. Model fit was evaluated using the Hosmer-Lemeshow test, and interactions between variables were tested. Sensitivity analyses were conducted to assess the robustness of the findings. A total of 119 patients (107 females and 12 males) were included in the analysis. No significant difference in age was found between sexes (t = -0.715, = 0.487), but disease duration was significantly shorter in males (t = 3.35, = 0.003). Logistic regression showed a significant association between male sex and infection risk (β = 0.9426, = 0.05), with males having an almost sixfold higher probability of infection compared to females (OR 5.675, 95% CI: 1.4479-22.2477, = 0.0127). Disease duration (β = 0.0250, = 0.102) and smoking status (β = 0.4529, = 0.078) were not statistically significant. Lastly, correlation analysis revealed a significant association between SS-A antibodies and infection rate (r = 0.291, = 0.003). This study highlights a significant sex-based disparity in the risk of infections among SLE patients, with males being at a higher risk compared to females. The differences in the distribution of infections, such as the higher prevalence of pneumonia in males and urinary tract infections in females, suggest that sex-specific factors, including immunological and hormonal differences, may influence infection susceptibility. Our findings emphasize the need for tailored clinical management, with increased vigilance for infections in male patients, to improve prevention strategies and targeted therapeutic interventions in this subgroup.
系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病，在临床表现和免疫表现方面具有显著的多样性。由于其女性与男性的比例约为9:1，人们普遍认识到系统性红斑狼疮主要影响女性，尤其是育龄女性。与普通人群相比，成年系统性红斑狼疮（SLE）患者更容易感染。然而，只有少数研究尝试使用实际生活数据来分析这种风险，甚至更少的研究成功评估了性别的影响。进行了一项回顾性研究，招募患者并根据其生物学性别将他们分为两组。从医疗记录中识别出感染发作，并按严重程度进行分类。根据疾病持续时间和接受的治疗对患者进行分层。使用逻辑回归分析来计算比值比（OR），并以95%置信区间（CI）评估风险因素。进行多变量逻辑回归以调整潜在的混杂因素。使用Hosmer-Lemeshow检验评估模型拟合情况，并测试变量之间的相互作用。进行敏感性分析以评估研究结果的稳健性。共有119名患者（107名女性和12名男性）纳入分析。性别之间在年龄上未发现显著差异（t = -0.715，P = 0.487），但男性的疾病持续时间明显较短（t = 3.35，P = 0.003）。逻辑回归显示男性性别与感染风险之间存在显著关联（β = 0.9426，P = 0.05），男性感染的可能性几乎是女性的六倍（OR 5.675，95% CI：1.4479 - 22.2477，P = 0.0127）。疾病持续时间（β = 0.0250，P = 0.102）和吸烟状况（β = 0.4529，P = 0.078）在统计学上不显著。最后，相关性分析显示SS - A抗体与感染率之间存在显著关联（r = 0.291，P = 0.003）。这项研究突出了SLE患者感染风险中基于性别的显著差异，男性比女性面临更高的风险。感染分布的差异，如男性肺炎患病率较高和女性尿路感染患病率较高，表明包括免疫和激素差异在内的性别特异性因素可能影响感染易感性。我们的研究结果强调了需要进行针对性的临床管理，提高对男性患者感染的警惕性，以改善该亚组的预防策略和针对性治疗干预措施。
