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目的研究分析狼疮性肾炎(LN)并发医院感染的临床特点及与临床、病理、治疗的关系。方法采用回顾性调查方法对住院治疗的LN149例患者进行医院感染部位及因素分析。结果LN医院感染部位常见于下呼吸道、泌尿道、皮肤软组织和消化道,分离菌株以革兰阴性杆菌、病毒、真菌为主;LN医院感染率为38.9%,病情恶化的11例中9例并发感染,其中5例直接死于严重感染;LN临床活动、病理类型呈Ⅲ、Ⅳ型者医院感染率较高,分别为30.0%和52.8%;尿蛋白、血白蛋白和肾功能与医院感染差异有统计学意义(P<0.01),LN激素应用时间、住院时间亦与医院感染差异有统计学意义(P<0.01);激素合并免疫抑制剂治疗,感染率较单用激素明显增高(P<0.01),而常规量激素联合环磷酰胺间歇冲击治疗和常规量激素联合他克莫司治疗,较大剂量激素联合环磷酰胺双冲击治疗,医院感染率明显下降(P<0.01)。结论LN医院感染率高达38.9%,与狼疮临床活动、病理、治疗方法及长期住院密切相关。
Objective To study the clinical characteristics of lupus nephritis (LN) complicated with nosocomial infection and its relationship with clinic, pathology and treatment. Methods A retrospective investigation was performed on hospital-acquired nosocomial sites and factors in LN149 hospitalized patients. Results LN hospital infection sites were common in the lower respiratory tract, urinary tract, skin and soft tissue and digestive tract. Gram-negative bacilli, viruses and fungi were the main pathogens in LN hospital. LN hospital infection rate was 38.9%, and 9 Infection, of which 5 died of serious infection directly; LN clinical activity, pathological types were Ⅲ, Ⅳ type of hospital infection rates were higher, respectively, 30.0% and 52.8%; urinary protein, serum albumin and renal function and hospital infection differences There was statistical significance (P <0.01). The application time and hospitalization time of LN hormone were also significantly different from those of nosocomial infection (P <0.01). The treatment of steroid combined with immunosuppressive drugs showed that the infection rate was significantly higher than that of hormone alone (P < 0.01). The combination of conventional hormones with cyclophosphamide intermittent shock therapy and conventional hormones combined with tacrolimus treatment resulted in a significant decrease in nosocomial infection rate (P <0.01) with larger doses of steroid combined with cyclophosphamide double impact therapy. Conclusion LN hospital infection rate as high as 38.9%, and lupus clinical activity, pathology, treatment and long-term hospitalization are closely related.