目的:侵袭性真菌感染(IFIs)是结缔组织病CTD患者中危及生命的机会性感染),可导致显著的发病率和死亡率。我们试图确定CTD中与IFIs相关的潜在危险因素。
方法:我们系统地搜索了PubMed,Embase,和CochraneLibrary数据库,用于从数据库开始到2023年2月1日发布的相关文章。
结果:本系统综述和荟萃分析包括26项研究。确定的国际金融机构的危险因素是糖尿病(比值比[OR],1.62;95%置信区间[CI],1.00to2.64),肺部疾病(OR3.43;95%CI2.49至4.73),间质性肺病(ILD;或,4.06;95%CI,2.22至7.41),肾脏疾病(OR,4.41;95%CI,1.84至10.59),糖皮质激素(GC)使用(OR,4.15;95%CI,2.74至6.28),特别是中等到高剂量的GC,硫唑嘌呤(AZA)使用(或,1.50;95%CI,1.12至2.01),钙调磷酸酶抑制剂(CNI)使用(OR,2.49;95%CI,1.59至3.91),霉酚酸酯(MMF)使用(或,2.83;95%CI,1.59至5.03),环磷酰胺(CYC)使用(OR,3.35;95%CI,2.47至4.54),生物制剂使用(或,3.43;95%CI,2.36至4.98),和淋巴细胞减少(或,4.26;95%CI,2.08至8.73)。使用羟氯喹(HCQ)可降低IFIs的风险(OR,0.67;95%CI,0.54至0.84)。此外,26项研究中有17项仅报道了CTD患者的肺孢子虫肺炎(PJP)的危险因素。肺部疾病;ILD;以及GC的使用,CNIs,CYC,甲氨蝶呤(MTX),MMF和生物制品,淋巴细胞减少增加了患PJP的风险,而HCQ的使用降低了其风险。
结论:糖尿病,肺部疾病,ILD,肾脏疾病,使用GC(尤其是中等至高剂量)和免疫抑制药物,发现淋巴细胞减少与CTD患者发生IFIs(尤其是PJP)的显著风险相关。此外,使用HCQ可以降低CTD患者发生IFIs的风险.
Invasive fungal infections (IFIs) are life-threatening opportunistic infections in patients with connective tissue disease CTD) that cause significant morbidity and mortality. We attempted to determine the potential risk factors associated with IFIs in CTD.
We systematically searched PubMed, Embase, and the Cochrane Library databases for relevant articles published from the database inception to February 1, 2023.
Twenty-six studies were included in this systematic
review and meta-analysis. Risk factors identified for IFIs were diabetes (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.00 to 2.64), pulmonary diseases (OR 3.43; 95% CI 2.49 to 4.73), interstitial lung disease (ILD; OR, 4.06; 95% CI, 2.22 to 7.41), renal disease (OR, 4.41; 95% CI, 1.84 to 10.59), glucocorticoid (GC) use (OR, 4.15; 95% CI, 2.74 to 6.28), especially moderate to high-dose GC, azathioprine (AZA) use (OR, 1.50; 95% CI, 1.12 to 2.01), calcineurin inhibitor (CNI) use (OR, 2.49; 95% CI, 1.59 to 3.91), mycophenolate mofetil (MMF) use (OR, 2.83; 95% CI, 1.59 to 5.03), cyclophosphamide (CYC) use (OR, 3.35; 95% CI, 2.47 to 4.54), biologics use (OR, 3.43; 95% CI, 2.36 to 4.98), and lymphopenia (OR, 4.26; 95% CI, 2.08 to 8.73). Hydroxychloroquine (HCQ) use reduced risk of IFIs (OR, 0.67; 95% CI, 0.54 to 0.84). Furthermore, 17 of the 26 studies only reported risk factors for Pneumocystis jiroveci pneumonia (PJP) in patients with CTD. Pulmonary disease; ILD; and the use of GC, CNIs, CYC, methotrexate (MTX), MMF and biologics, and lymphopenia increased the risk of PJP, whereas the use of HCQ reduced its risk.
Diabetes, pulmonary disease, ILD, renal disease, use of GC (especially at moderate to high dose) and immunosuppressive drugs, and lymphopenia were found to be associated with significant risk for IFIs (especially PJP) in patients with CTD. Furthermore, the use of HCQ may reduce the risk of IFIs in patients with CTD.