背景:自保留皮质类固醇的药物问世以来,系统性红斑狼疮(SLE)的致命性较低。SLE患者的死亡率仍然高于普通人群。据报道,传染病是SLE患者死亡的主要原因之一。尽管细菌是SLE患者中最常见的病原体,肺孢子虫肺炎(PJP)比细菌感染更致命。
方法:我们回顾性地纳入了2014年1月至2022年12月在我们中心的SLE并发PJP(SLE-PJP)的连续患者。参与者分为两组:幸存者和非幸存者。进行Cox回归模型和Kaplan-Meier生存分析以探讨生存的预后因素。
结果:SLE患者57例(42.0±15.8岁,78.9%女性)患有PJP,其中22人(38.6%)死亡。与生存组相比,非生存组有更多的高血糖或糖尿病患者,有创通气(p<0.01),呼吸衰竭,重症监护室入院,无创通气,和医院获得性肺炎(p<0.05)。非存活组的中性粒细胞百分比更高,乳酸脱氢酶,D-二聚体(p<0.001),尿素,高敏C反应蛋白(hsCRP),红细胞沉降率(ESR),和铁蛋白(p<0.05)。它的微量白蛋白也较低,血红蛋白(p<0.001),免疫球蛋白G,补体3,外周血淋巴细胞计数,血小板,NK细胞计数,和CD4+T细胞计数(p<0.05)。多因素分析提示高血糖或糖尿病(HR=4.25,p<0.01,95%CI:1.51-11.97),血小板减少症(HR=4.22,p<0.01,95%CI:1.63-10.91)和低补体3(C3)(HR=4.06,p<0.01,95%CI:1.60-10.33)是SLE-PJP患者生存的独立危险因素。
结论:SLE-PJP患者的死亡率仍然很高。高血糖症,C3降低和血小板减少是独立的生存危险因素。
BACKGROUND: Systemic lupus erythematosus (SLE) has been less deadly since the advent of corticosteroid-sparing medications. SLE patients still have a higher mortality rate than the general population. Infectious disease is reported as one of the major causes of death in patients with SLE. Although bacteria are the most often isolated pathogens from patients with SLE, Pneumocystis jirovecii pneumonia (PJP) is more deadly than bacterial infection.
METHODS: We retrospectively enrolled consecutive patients with SLE concurrent with PJP (SLE-PJP) in our center between January 2014 and December 2022. The participants were classified into two groups: survivors and non-survivors. Cox regression models and Kaplan‒Meier survival analyses were conducted to explore prognostic factors for survival.
RESULTS: There were 57 patients with SLE (42.0 ± 15.8 years old, 78.9% female) complicated with PJP, 22 (38.6%) of whom died. Compared with the survival group, the non-survival group had more patients with hyperglycemia or diabetes mellitus, invasive ventilation (p < 0.01), respiratory failure, intensive care unit admission, non-invasive ventilation, and hospital-acquired pneumonia (p < 0.05). The non-survival group showed a higher neutrophil percentage, lactate dehydrogenase, D-dimer (p < 0.001), urea, high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), and ferritin (p < 0.05). It also had lower minimal albumin, hemoglobin (p < 0.001), immunoglobulin G, complement 3, peripheral lymphocyte count, platelet, NK cell count, and CD4+ T-cell count (p < 0.05). Multivariate analysis indicated that hyperglycemia or diabetes mellitus (HR = 4.25, p < 0.01, 95% CI: 1.51-11.97), thrombocytopenia (HR = 4.22, p < 0.01, 95% CI: 1.63-10.91) and lower complement 3 (C3) (HR = 4.06, p < 0.01, 95% CI: 1.60-10.33) were independent risk factors for the survival of SLE-PJP patients.
CONCLUSIONS: The mortality rate of patients with SLE-PJP is still high. Hyperglycemia, decreased C3, and thrombocytopenia are independent survival risk factors.