目的:探讨原发性干燥综合征(pSS)合并间质性肺病(ILD)的临床和实验室特点,探讨pSS-ILD患者呼吸道感染的危险因素。
方法:纳入2015-2020年北京大学人民医院162例pSS-ILD患者的队列,所有的医疗记录都被完全收集了.我们筛选了53例呼吸道感染患者作为研究病例,与109个年龄和性别匹配的对照相比。比较感染组与对照组的差异。进行单变量和多变量二元logistic回归测试以确定pSS-ILD患者呼吸道感染的潜在危险因素。
结果:在162例pSS-ILD患者中,32.72%(53/162)患有呼吸道感染。最常见的ILD类型是非特异性间质性肺炎(32.08%,51/159),最常见的病原体类型是细菌(64.25%,34/53)。感染组ESSDAI水平较高(P<0.001),CRP(P<0.001),ESR(P=0.003),和C3(P=0.020),但DLCO-SB水平较低(P=0.015)。单因素Logistic模型显示,PAH和糖皮质激素的使用增加了pSS-ILD患者的感染风险。在多元逻辑回归分析中,PAH(OR=3.993,95%CI=1.192-13.373,P=0.025)和DLCO严重减少(DLCO-SB<40%,OR=4.625,95%CI=1.281-16.702,P=0.019)与pSS-ILD患者呼吸道感染风险增加显着相关。
结论:在pSS-ILD患者中,最常见的ILD类型是非特异性间质性肺炎.在感染患者中,细菌是最常见的病原体。更高水平的ESSDAI,CRP,ESR,和C3可能与感染风险增加相关。PAH和DLCO减少是独立的危险因素。要点•ILD和传染病严重影响pSS患者状况。•更高水平的ESSDAI,CRP,ESR,C3可能与pSS-ILD感染风险增加有关。•PAH和DLCO减少被确定为下呼吸道感染的独立危险因素。
OBJECTIVE: To explore clinical and laboratory characteristics of primary Sjögren\'s syndrome (pSS) complicated with interstitial lung disease (ILD) and investigate the risk factors for respiratory infections in pSS-ILD.
METHODS: A cohort of 162 pSS-ILD patients in Peking University People\'s Hospital from 2015 to 2020 were included, and all medical records were completely collected. We screened 53 patients suffering from respiratory infections as
study cases, compared with 109 age- and sex-matched controls. Differences between infection group and control group were compared. Univariate and multivariate binary logistic regression tests were conducted to identify potential risk factors for respiratory infections in pSS-ILD patients.
RESULTS: Among 162 pSS-ILD patients, 32.72% (53/162) suffered from respiratory infections. The most frequent type of ILD was nonspecific interstitial pneumonia (32.08%, 51/159), and the most common type of pathogen was bacteria (64.25%, 34/53). Infection group showed higher levels of ESSDAI (P < 0.001), CRP (P < 0.001), ESR (P = 0.003), and C3 (P = 0.020) but lower level of DLCO-SB (P = 0.015). Univariate logistic model revealed that PAH and the use of glucocorticoid increased infection risk in pSS-ILD patients. On multivariate logistic regression analysis, PAH (OR = 3.993, 95% CI = 1.192-13.373, P = 0.025) and severe reduction of DLCO (DLCO-SB < 40%, OR = 4.625, 95% CI = 1.281-16.702, P = 0.019) were significantly associated with increased risk of respiratory infections in pSS-ILD patients.
CONCLUSIONS: Among pSS-ILD patients, the most frequent type of ILD was nonspecific interstitial pneumonia. In patients with infection, bacteria were the most common pathogen. Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risk. PAH and reduction of DLCO were identified as independent risk factors. Key Points • ILD and infectious diseases severely affect pSS patient conditions. • Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risks in pSS-ILD. • PAH and reduction of DLCO were identified as independent risk factors for lower respiratory infection.