探討在重症加護病房紅斑性狼瘡患者侵入性黴菌感染的預後及危險因子：回溯性研究

The prognosis and risk factors of invasive fungal infections in patients with systemic lupus erythematosus admitted to an intensive care unit: a retrospective study

目的：本研究探討在一個醫療中心重症加護病房的紅斑性狼瘡患者侵襲性黴菌感染的預後和危險因子。方法：此為回溯性研究，自2005年1月至2011年12月，收集在重症加護病房的紅斑狼瘡病患臨床資料，分析細菌性感染與侵入性黴菌感染病患其臨床表現及檢查結果。結果：共32名紅斑性狼瘡病患住進重症加護病房，其中有19（59.3%）人得到感染，8（25%）人是單純細菌性感染，另外11（34.38%）人合併有侵入性黴菌感染。合併侵入性黴菌感染的死亡率約81.8%。單純細菌性感染的病人與合併侵入性黴菌感染的病人相比，合併侵入性黴菌感染的病人有淋巴球低下且較少表現發燒。其他可能相關的危險因子包括：口腔念珠菌感染，腎臟替代療法及貧血。結論：合併侵入性黴菌感染死亡率高，危險因子有：少發燒及合併淋巴球低下。

Objective: To investigate the prognosis and risk factors of invasive fungal infections in patients with systemic lupus erythematosus admitted to the intensive care unit of one medical center. Methods: We retrospectively obtained clinical and laboratory data and the results of bacterial and invasive fungal infection analyses in patients diagnosed with systemic lupus erythematosus who were admitted to the intensive care unit of our medical center between 2005 and 2011. Results: A total of 32 patients were enrolled, 19 (59.3%) of whom had infections. Eight (25%) patients only had bacterial infections, and 11 (34.38%) had co-existing invasive fungal infections. The mortality rate from the co-existing invasive fungal infections was 81.8%. A low incidence of fever (36.36%) and low lymphocyte count (290.67 ± 293.89 /mm3) were the most common symptoms in the patients with coexisting invasive fungal infections. Other possible risk factors Included oral candidiasis, renal replacement therapy and anemia. Conclusions: The mortality rate from the co-existing invasive fungal infections was high, and the risk factors were lower lymphocyte count and a lower fever response.