Iliopoulos A G, Tsokos G C
Department of Clinical Physiology, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
Semin Arthritis Rheum. 1996 Apr;25(5):318-36. doi: 10.1016/s0049-0172(96)80018-7.
This study reviews the pertinent immunopathologic mechanisms that contribute to increased susceptibility to infection in patients with systemic lupus erythematosus (SLE) and the spectrum of infections in patients with SLE. It assesses the impact on patient care, morbidity, and mortality.
The authors performed an extensive search of the literature through MEDLINE, using appropriate keywords and manual search of bibliography cited by retrieved papers.
Infection is a leading cause of morbidity and mortality in SLE and may change the natural course of the disease. Patients with SLE display numerous cellular and humoral abnormalities that are expressed in a heterogeneous pattern and contribute in varying degrees to susceptibility to infectious agents. The use of corticosteroid and immunosuppressive drugs is only partially responsible for the high infection rate in lupus patients. Common as well as opportunistic pathogens are frequently encountered among patients with SLE. The susceptibility that SLE patients exhibit to certain bacteria is now better recognized, and a broadening spectrum of pathogens is being reported. The immunization of patients against influenza and pneumococcus and the administration of prophylactic therapy against Pneumocystis carinii infection in certain patients have recently been proposed.
Disease activity and treatment are responsible for the extensive defects of the immune defense system in lupus patients that increase their susceptibility to an extensive range of infections. Infection imposes a serious burden on lupus patients and on the caring physician.
本研究回顾了系统性红斑狼疮（SLE）患者感染易感性增加的相关免疫病理机制以及SLE患者的感染谱。评估其对患者护理、发病率和死亡率的影响。
作者通过MEDLINE对文献进行了广泛检索，使用了适当的关键词，并对检索论文引用的参考文献进行了手工检索。
感染是SLE患者发病和死亡的主要原因，可能改变疾病的自然进程。SLE患者表现出多种细胞和体液异常，呈异质性模式表达，不同程度地导致对感染病原体的易感性。糖皮质激素和免疫抑制药物的使用只是狼疮患者高感染率的部分原因。SLE患者中常见病原体和机会性病原体均经常出现。SLE患者对某些细菌的易感性目前已得到更好的认识，并且有报道称病原体谱正在扩大。最近有人提议对患者进行流感和肺炎球菌免疫接种，并对某些患者给予卡氏肺孢子虫感染的预防性治疗。
疾病活动和治疗导致狼疮患者免疫防御系统存在广泛缺陷，增加了他们对多种感染的易感性。感染给狼疮患者和护理医生带来了沉重负担。
