J Rheumatol:巨细胞病毒或耶氏肺孢子虫肺炎增加系统性红斑狼疮患者肺出血的死亡率

2018-12-09 xiangting MedSci原创

鉴于CMV/PJP的高患病率及其与死亡率的关联,建议对所有合适的伴PH的SLE患者进行常规BALF分析。

这项研究旨在探讨巨细胞病毒或耶氏肺孢子虫肺炎(CMV/PJP)在系统性红斑狼疮患者(SLE)肺出血(PH)中的作用。

研究回顾性分析了27例接受支气管肺泡灌洗液(BALF)分析并伴PH的SLE患者病历。比较了伴和不伴CMV/PJP患者的临床特征和死亡率。分析了PH相关死亡率的危险因素。

27例伴PH的SLE患者中,15例患者BALF样本中有病原体,8例有CMV/PJP。尽管接受了CMV/PJP治疗,但伴CMV/PJP的SLE患者90天和180天死亡率RR高于不伴这些感染的患者(分别为5.94,95%CI 1.44-24.48;7.13,95%CI 1.81-28.06)。90天和180天死亡率的危险因素是存在CMV/PJP(分别为OR 14.2,95%CI 1.83-109.9;OR 25.5,95%CI 2.91-223.3)和使用甲泼尼龙冲击疗法用于治疗PH(分别为OR 12.0,95%CI 1.48-97.2;OR 8.5,95%CI 1.13-63.9)。增加90天死亡率的因素是机械通气持续时间超过14天(OR 11.1,95%CI 1.11-112.0)和PH出现时使用激进性免疫抑制治疗(OR 7.56,95%CI 1.09-52.4)。接受激进性免疫抑制治疗的7名患者中3名在有CMV/PJP的情况下死亡。

鉴于CMV/PJP的高患病率及其与死亡率的关联,建议对所有合适的伴PH的SLE患者进行常规BALF分析。在PH发作期间,使用激进性免疫抑制治疗不能使机会性感染SLE患者获益。

原始出处:

Yi-Syuan Sun. Cytomegaloviral or Pneumocystis Jiroveci Pneumonia Increases Mortality in Systemic Lupus Erythematosus Patients with Pulmonary Hemorrhage: Evidence from Bronchoalveolar Lavage Fluid. J Rheumatol. 01 December 2018.

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    2018-12-11 zhouqu_8
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    2018-12-11 wwzzly

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