A Meta Analysis For Risk Factors Of Systemic Lupus Erythematosus Complicated With Fungal Infection

Objectives: To systematically analysis risk factors of systemic lupus erythematosus complicated with fungal infection, and infection strains species and sites at home and abroad.Methods: Retrieve the published literature involved in the systemic lupus erythematosus and fungal infection in both Chinese and English from the database-built to February 2017 by searching the following databases,PubMed, Metstr,Uptodate, Wanfang med online, CNKI, and Dayi100.According to the inclusion and exclusion criteria, we screen out the case-control studies in accordance with of criteria,conduct quality evaluation of the Newcastle-OttawaScale (NOS), and extract the characteristics from literature.Meta analysis is implemented by RevMan5.2 provided by Cochrane collaboration. Merging effect index is calculated for each risk factor:odds ratio (OR) and 95% confidence interval (95% CI), in combination with P values,to evaluate the correlation between risk factors and fungal infection in patients with systemic lupus erythematosus. Meanwhile, some data information is summarized to analysis infection fungal strains species as well as infection sites.Results: Ten articles are included in this study,four English literature,six in Chinese.The cumulative cases are 386 cases with 1216 cases of control groups, which involved nine risk factors. The merger OR [95% CI] and P values are respectively:(1)sex 1.17 [0.79, 1.73], P = 0.43, (2) age 1.32 [-2.15, 4.79], P = 0.46, (3) the course of SLE -3.88 [-15.60, 7.85], P = 0.52, (4) glucocorticoids 4.40 [1.82, 10.68], P =0.001, (5) immunosuppressants 2.07 [1.17, 3.69], P = 0.01, (6) antibiotics 11.17 [7.06,17.66], P < 0.00001, (7) hypoalbuminemia 1.87[0.16, 21.86], P = 0.62 (8) CRP-8.95[-43.88,25.97], P ＝ 0.62 (9) SLEDAI 3.26 [0.46, 6.06], P = 0.02. Component ratio of infection strains is as follows: candida albicans 46.6%, candida tropicalis 8.7%,candida glabrata 6.3%, candida krusei 4.4%, aspergillus 10.8%, Cryptococcus neoformans 14.5%, others 8.7%. In terms of infection sites rate, it shows: oral cavity 40.3%, lower respiratory tract (lung) 32.4%, gastrointestinal tract 7.3%, urogenital tract 5.1% , blood system 2.2%, central nervous system 5.4%, bone marrow 0.2%,skin 5.7%, others 1.4%.Conclusions:1. The doubtless risk factor of systemic lupus erythematosus complicated with fungal infection is the use of antibiotics, but the results in glucocorticoids(GC), immune inhibitors,SLE disease activity score (SLEDAI) are respectively related to hormone use dose and regional sources of study population.(1) GC dosage of higher than low-dose boundaries (≥15 mg/d or≥45 mg/d) is the risk factor of systemic lupus erythematosus (sle) complicated with fungal infection,however high-dose GC pulse therapy is not the infection risk factor.(2) Risk factors involved in immune inhibitors and SLEDAI are related to region,they are risk factors in American people but not in Asian population.2. The gender, age, course of SLE, hypoalbuminemia and CRP are not fungal infection risk factors for systemic lupus erythematosus.3. In terms of fungal infection strains species and location, three of the most common strains are candida albicans (46.6%), cryptococcus neoformans (14.5%),and aspergillus (10.8%); Frequent Infection location is in turn the oral cavity (40.3%),lung (32.4%), gastrointestinal tract (7.3%), while the infection rate of skin(5.7%),central nervous system (5.4%) and urinary reproductive system (5.1%) is relatively small.