台灣紅斑性狼瘡患者隱球菌性腦膜炎之感染風險

High risk of cryptococcal meningitis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study

目的：系統性紅斑狼瘡（SLE）是一種自體免疫疾病，增加了感染機會性感染的風險，包括罕見但致命的中樞神經系統感染如隱球菌性腦膜炎（CM）。由於其緩慢進展，CM的診斷常被延誤。本研究旨在通過全國性、基於人群的分析，探討SLE患者感染CM的風險及相關風險因素。
方法：本研究利用2006年至2017年台灣國家健康保險數據庫進行基於人群的匹配隊列研究。研究納入11,472名SLE患者與57,360名按年齡和性別匹配的對照組（1:5比例）。利用Cox模型評估SLE隊列中的CM風險。
結果：本研究顯示SLE與CM風險呈正相關，不論性別與年齡（校正風險比[aHR] = 7.73，p <.001）。特別是年齡超過65歲的患者，SLE相對非SLE隊列的CM風險顯著增加（aHR 6.35，p <0.05）。此外，靜脈注射類固醇和中風史與較高的CM風險相關（aHR 8.81，p <0.05和aHR8.04，p<0.05）。
結論：SLE患者相比於非SLE患者具有更高的CM風險。需要進一步研究來揭示其潛在機制。

Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease that increases susceptibility to opportunistic infections, including rare but deadly central nervous system infections such as cryptococcal meningitis (CM), which often leads to delayed diagnosis owing to its slow progression. In this study, we aimed to fill the gap in understanding the risk of CM in patients with SLE through a nationwide population-based analysis, addressing the need for evidence of associated risk factors.
Methods: A population-based matched cohort study was performed using data from the Taiwan National Health Insurance database between 2006 and 2017. A total of 11,472 patients with SLE and 57,360 randomly selected age- and sex-matched controls (1:5) were included in this study. The risk of CM in the SLE cohort was evaluated using a Cox model.
Results: This study revealed a positive association between SLE and the risk of CM, regardless of sex or age (adjusted hazard ratio [aHR]: 7.73, p <0.001). In particular, the relative risk of CM in the SLE cohort significantly increased in patients aged >65 years (aHR: 6.35, p <0.05). Furthermore, intravenous steroid use and a history of stroke were associated with a higher risk of CM (aHR: 8.81, p <0.05, and aHR: 8.04, p <0.05, respectively).
Conclusions: Patients with SLE have a higher risk of developing CM compared to individuals without SLE. Additionally, the most important identified risk factors for CM in these patients were older age, liver disease, stroke and recent intravenous steroid therapy.