紅斑性狼瘡病人合併侵入性黴菌感染

Invasive fungal infections in systemic lupus erythematosus: 10-year experience in a teaching hospital in Taiwan

目的：侵入性黴菌感染在紅斑性狼瘡的病人之中雖是少見但卻往往是致命的感染，並且早期診斷常常相當的困難。這篇文章的目的是要探討在紅斑性狼瘡病人合併侵入性黴菌感染的危險因子。方法：從1999年至2008年在台大醫院共有18名紅斑性狼瘡的病人被診斷合併侵入性黴菌感染，我們分析這些病人的臨床特性。結果：86% 的病人合併有狼瘡腎炎，66.7% 的病人在侵入性黴菌感染前三個月內曾經使用過脈衝式環磷醯胺治療，並且所有的病人都使用超過三週的類固醇治療。55.5% 的病人在侵入性黴菌感染前因為細菌細菌血症而使用過廣效性抗生素。這些有侵入性黴菌感染的紅斑性狼瘡病人死亡率高達66%，死亡個案比非死亡個案在侵入性黴菌感染的過程中血小板數量有逐漸降低的趨勢，並且達到統計學上顯著性的意義（p<0.05）。結論：這可能暗示著持續降低的血小板數量可能是紅斑性狼瘡的病人感染侵入性黴菌的危險因子。

Objective: The objective of this study was to investigate possible risk factors associated with invasive fungal infections in SLE patients. Methods: Between Jan 1999 and June 2008, eighteen cases of SLE with invasive fungal infection were recorded at National Taiwan University Hospital. We collected and analyzed the clinical characteristics and laboratory data from the retrospective medical records. Results: Lupus nephritis was the most common manifestation (84%). More than half of the patients received cyclophasphamide pulse therapy (66.7%) within 3 months of the invasive fungal infection and all were treated with steroids for a prolonged period of time (>3 weeks). Broad-spectrum antibiotics for proved bacteremia were noticed in 55.5% of the patients. Most of the invasive fungal infections were difficult to diagnose in early stages resulting in poor clinical outcomes (mortality rate: 66%). A significant decreased platelet count (p<0.05) was noted in the mortality group compared to the survivor group. Patients with mold infections were younger but still showed a high mortality. Conclusion: A significant decreased platelet count might be an adverse predictor in SLE patients with invasive fungal infections.