全身性紅斑狼瘡患者罹患細菌性腦膜炎的危險因子分析：台灣全國性人口為基礎的回顧性研究

Risk Factors Associated with the Increased Incidence of Bacterial Meningitis in Patients with Systemic Lupus Erythematosus in Taiwan: A Nationwide Population-based Study Retrospective Study

目的：全身性紅斑狼瘡是一種以器官損傷和多種臨床併發症為特徵的全身性自體免疫疾病。細菌性腦膜炎是潛在致命的中樞神經系統感染，過去文獻指出死亡率範圍為12%至50%。我們旨在評估全身性紅斑狼瘡患者患上細菌性腦膜炎的風險並確定相關危險因子。
方法：我們從全民健康保險資料庫中回顧性研究全身性紅斑狼瘡患者，並比較其與非全身性紅斑狼瘡患者對照組的細菌性腦膜炎發生率。為評估全身性紅斑狼瘡患者群體的細菌性腦膜炎風險，我們使用了Cox多變量比例風險模型進行分析。
結果：本研究納入11,460名全身性紅斑狼瘡確診患者和57,300名非全身性紅斑狼瘡個體。參與者的平均年齡為42.36歲（標準差：16.66歲），其中85.43%為女性。在六年的追蹤期內，全身性紅斑狼瘡患者的細菌性腦膜炎發生率顯著較高（每10萬人年45.33 vs. 1.53，HR 29.14，95% CI 12.21–69.55，p<0.0001）。Kaplan–Meier分析證實全身性紅斑狼瘡患者的累積發病率較高（p<0.0001）。經過調整的Cox迴歸確認全身性紅斑狼瘡是獨立的風險因子（adjusted HR 22.59，95% CI 9.18–55.62，p<0.0001）。在全身性紅斑狼瘡患者中，男性、合併慢性腎臟病、敗血症易感性和口服皮質類固醇(prednisolone)平均劑量超過7.5 mg是與細菌性腦膜炎相關的獨立風險因子。
結論：全身性紅斑狼瘡患者明顯增加患上細菌性腦膜炎的風險。在全身性紅斑狼瘡群體中，與細菌性腦膜炎相關的風險因子包括男性、合併慢性腎臟病、敗血症易感性和接受口服皮質類固醇(prednisolone)平均劑量超過7.5 mg。

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by organ damage and various clinical complications. Bacterial meningitis (BM) is a potentially life-threatening central nervous system infection with reported mortality rates ranging from 12–50%. We aimed to evaluate this risk and identify factors related to BM in patients with SLE.
Methods: We retrospectively identified patients with SLE from the National Health Insurance research-oriented database and compared the incidence of BM with that of non-SLE controls. We used a Cox multivariate proportional hazards model to assess the risk of BM in the SLE cohort.
Results: This study included 11,460 patients diagnosed with SLE and 57,300 non-SLE individuals. The participants had a mean age of 42.36 years (standard deviation: 16.66years) and 85.43% were female. Over a six-year follow-up, SLE cohort exhibited significantly higher BM incidence (45.33 vs. 1.53 per 100,000 person-years, hazard ratio [HR] 29.14, 95% confidence interval [CI] 12.21–69.55, p<0.0001). Kaplan–Meier analysis confirmed a higher cumulative incidence in patients with SLE (p<0.0001). Adjusted Cox regression confirmed SLE as an independent risk factor (adjusted HR 22.59, 95% CI 9.18–55.62, p<0.0001). Independent risk factors in patients with SLE included male sex, chronic kidney disease, sepsis predisposition, and prednisolone dose >7.5 mg.
Conclusions: Patients with SLE exhibited a significantly increased risk of BM. The risk factors associated with BM in the SLE cohort included male sex, chronic kidney disease as a comorbidity, predisposing factors for sepsis, and receiving a mean prednisolone dose >7.5 mg.