感染症對接受類固醇治療的全身性紅斑性狼瘡病人之預後的影響

Influence of Infection on Prognosis of Systemic Lupus Erythematosus Patients Receiving Corticosteroid Treatment

吾人研究126位自1980至1990年間，經台大醫院內科風濕病部門評估或治療，且臨床上懷疑有感染症的全身性紅斑性狼瘡病人，觀察其治療中感染症之嚴重性及對預後之影響，尤其特別注意與使用類固醇之關係。結果發現，當病人接受較高劑量的類固醇治療時，會有較高的感染率。每日類固醇劑量超過30毫克時，俟機性微生物的感染比率亦隨之升高。金黃色葡萄球菌，非傷寒性沙門氏桿菌及肺結核桿菌是紅斑性狼瘡病人可見到的致病菌。臨床上使用大量類固醇治療會降低紅斑性狼瘡病人免疫力，且併發感染症引起全身性紅斑性狼瘡病情惡化。本研究中，感染占全身紅斑性狼瘡病人死因的半數，對預後有很大影響。

A total of 126 systemic lupus erythematosus patients, clinically suggestive of infection, evaluated or treated by the rheumatological section of the National Taiwan University Hospital from 1980 to 1990 were investigated Analysis of their data showed that the average infection rate was increased in patients treated with higher steroid dosage. When daily doses of prednisolone exceeded 30mg, there was a higher frequency of infection with opportunistic wicroorgaaism. In addition, Staphylococcus aureus, nontyphoid salmnonella and Mycobacterium tuberculosis were not uncommon infectious agents in systemic death, and had grave influence on pragnosis of patients with systemic lupus erythematosus in the present series.