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    李晓悦, 王丽丽, 王信, 黄鸿影, 陈琳洁. 原发性干燥综合征合并感染的临床特点及危险因素分析[J]. 蚌埠医科大学学报, 2021, 46(6): 760-766. DOI: 10.13898/j.cnki.issn.1000-2200.2021.06.014
    引用本文: 李晓悦, 王丽丽, 王信, 黄鸿影, 陈琳洁. 原发性干燥综合征合并感染的临床特点及危险因素分析[J]. 蚌埠医科大学学报, 2021, 46(6): 760-766. DOI: 10.13898/j.cnki.issn.1000-2200.2021.06.014
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    LI Xiao-yue, WANG Li-li, WANG Xin, HUANG Hong-ying, CHEN Lin-jie. Analysis of clinical characteristics and risk factors in primary Sjögren's syndrome with infection[J]. Journal of Bengbu Medical University, 2021, 46(6): 760-766. DOI: 10.13898/j.cnki.issn.1000-2200.2021.06.014
    Citation: LI Xiao-yue, WANG Li-li, WANG Xin, HUANG Hong-ying, CHEN Lin-jie. Analysis of clinical characteristics and risk factors in primary Sjögren's syndrome with infection[J]. Journal of Bengbu Medical University, 2021, 46(6): 760-766. DOI: 10.13898/j.cnki.issn.1000-2200.2021.06.014
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    原发性干燥综合征合并感染的临床特点及危险因素分析

    Analysis of clinical characteristics and risk factors in primary Sjögren's syndrome with infection

      摘要
    • 摘要:
      目的探讨原发性干燥综合征(primary Sjögren's syndrome，pSS)合并感染的临床特点及危险因素。
      方法197例pSS病人根据是否合并感染分为感染组(52例)和非感染组(145例)，了解感染组的感染部位和病原体类型，并对感染相关的可疑危险因素，运用二元logistic回归逐步进行单因素和多因素分析。
      结果本研究中pSS病人感染发生率为26.4%(52/197)，最常见的感染部位是呼吸道(52.7%)和泌尿道(21.8%)，其余分别是皮肤、软组织(12.7%)、败血症(5.5%)、中枢神经系统(3.6%)、消化道(1.8%)及生殖系统(1.8%)。感染病原体中最常见的是细菌(67.3%)，其余依次是病毒(25%)、真菌(7.7%)、支原体(7.7%)，混合感染4例。细菌感染中又以大肠埃希菌和肺克雷伯杆菌等革兰阴性杆菌最为常见，且对喹诺酮类或头孢菌素类抗生素的耐药率均较高。感染组的年龄、病程、血清胆固醇、三酰甘油、C反应蛋白、pSS病情活动度评分病人主观症状评分(ESSPRI)和病人客观表现评分(ESSDAI)、干燥程度及疲乏程度、肺脏受累发生率、糖皮质激素的使用率均高于非感染组(P < 0.05~P < 0.01)，且感染组的总蛋白及白蛋白含量均低于非感染组(P < 0.01)，pSS疾病高度活动组感染率明显高于病情稳定组与轻度活动组(P < 0.05)。logistic单因素回归分析显示年龄大、ESSDAI评分高、ESSPRI评分高、疲乏程度高、干燥程度高、血清总蛋白低、白蛋白低、血清胆固醇高、三酰甘油高、C反应蛋白高、肺脏受累是pSS合并感染的危险因素(P < 0.05~P < 0.01)。多因素回归分析显示ESSDAI评分高、干燥程度高、血清三酰甘油高、肺脏受累是pSS合并感染的独立危险因素(P < 0.05~P < 0.01)。
      结论pSS病人感染的发病率较高，最常见的感染部位是呼吸道和泌尿道，最常见的感染病原体是大肠埃希菌和克雷伯杆菌等革兰阴性杆菌。ESSDAI评分高、干燥程度高、血清三酰甘油高、肺脏受累是原发性干燥综合征合并感染的独立危险因素，临床工作中应予以重视。

       

      Abstract:
      ObjectiveTo explore the clinical characteristics and related risk factors in patients with primary Sjögren's syndrome(pSS) with infection.
      MethodsIn this retrospective study, 197 patients with pSS were divided into infection group(n=52) and non-infection group(n=145), the characteristics of their infections including the infection sites and pathogens were investigated.The suspicious risk factors of infection in patients with pSS were assessed by bivariate logistic regression analysis, univariate factor analysis and multivariate factor analysis.
      ResultsIn this study, infection incidence in pSS in this study was 26.4%(52/197).The most common sites of infection were the respiratory tract(52.7%) and the urinary tract(21.8%), followed by skin and soft tissue(12.7%), septicemia(5.5%), central nervous system(3.6%), digestive tract(1.8%) and reproductive system(1.8%).Bacteria are the most common pathogens of infection(67.3%), followed by viruses(25%), fungi(7.7%), mycoplasma(7.7%), with four cases of mixed infection.Gram-negative bacilli such as Escherichia coli and Klebsiella are the most common bacterial infections, which have the high resistance to antibiotics especially quinolones and cephalosporins.The age, course of disease, serum cholesterol, triglyceride, C reactive protein, EULAR Sjögren's syndrome disease activity index(ESSDAI), EULAR Sjögren's syndrome patient reported index(ESSPRI) score, degree of dryness and degree of fatigue, incidence of lung involvement and the utilization rate of glucocorticoid in the infection group were all higher than those in the non-infection group(P < 0.05 to P < 0.01), and the total protein and albumin level in the infection group were lower than those in the non-infection group(P < 0.01).The infection rate of pSS patient in highly active group was significantly higher than that in the stable group and the mildly active group(P < 0.05).Logistic univariate regression analysis showed that old age, high ESSDAI score, high ESSPRI score, high fatigue degree, high dryness degree, low serum total protein, low albumin, high serum cholesterol, high triglyceride, high C reactive protein, pulmonary involvement were risk factors for pSS complicated with infection(P < 0.05 to P < 0.01).Logistic multivariate regression analysis showed that high ESSDAI score, high dryness degree, high serum triglyceride and pulmonary involvement were independent risk factors for pSS complicated with infection(P < 0.05 to P < 0.01).
      ConclusionsThe incidence of infection in pSS is high, respiratory and urinary tract are the most common sites of infection in pSS patients.The most common infection pathogens are Escherichia coli and Klebsiella.Moreover, high ESSDAI score, high degree of dryness, high serum triglyceride and pulmonary involvement are the independent risk factors for pSS complicated with infection, which should be attached importance to in clinical works.

       

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