Characteristics And Risk Factors Of Systemic Lupus Erythematosus Complicated With Lower Respiratory Tract And Pulmonary Bacterial Infection

Objective : To analyze the clinical manifestations,auxiliary examination and treatment of systemic lupus erythematosus(SLE)patients with lower respiratory tract and pulmonary bacterial infection,to understand the clinical characteristics of SLE patients with lower respiratory tract and pulmonary bacterial infection,and to explore the main risk factors of SLE patients with lower respiratory tract and pulmonary bacterial infection,so as to provide reference and reference for clinical diagnosis and prevention.Methods:From October 2015 to January 2018,85 hospitalized patients diagnosed as SLE complicated with lower respiratory tract and pulmonary bacterial infection in the department of rheumatology and immunology of the first affiliated hospital of Bengbu medical college were selected as the infection group.At the same time,85 SLE patients who had been excluded from infection were selected from SLE patients who were hospitalized in the same period according to the ratio of 1: 1 as the control group.Through a case-control study,the differences between the two groups in general clinical data,clinical manifestations,auxiliary examination and treatment were compared and analyzed,and the risk factors were established.SPSS 16.0 software was used for statistical analysis.Results :1.Comparison of clinical data between infected group and control group: patient age,age≥45 years,hospitalization days,hospitalization days>3 weeks,SLEDAI score,≥2 affected organs,lung lesions,pulmonary interstitial lesions,lupus Nephritis,cardiac involvement,the difference was statistically significant(P <0.05).2.All patients in the study underwent etiological examination.Among 85 patients with bacterial infection,45 were co-cultured,of which 10 were mixed infections,and 7 were bacterial infections and fungal infections.The main strains infected were gram-negative bacteria,a total of 28 cases were isolated,accounting for 62.22% of the composition ratio,mainly Escherichia coli 12 strains,Klebsiella pneumoniae 7;Gram-positive bacteria are Staphylococcus aureus the main,a total of 5 strains.In the mixed infection,the fungal infection was dominant,and 2 Aspergillus strains were cultured.The other five strains were Candida albicans.White colonies were seen in the patient’s oral cavity and the main oral infections were found.3.All patients in this study underwent imaging examinations,of which 68 had imaging findings and 17 had no imaging changes.Pleural lesions: Pleural effusion(including one or both sides)in 15 cases,pleural thickening in 22 cases.Pleural effusion to one or both sides of the lung insufficiency in 6 cases.Cardiac changes: 11 cases of pericardial effusion and 1 case of pericardial hypertrophy.Pulmonary interstitial lesions: There were 6 cases of increased glass-like density,28 cases of increased cord-like density,and 6 cases of increased grid-like and cellular density.Pulmonary infective(parenchymal)lesions: 61 cases of thickened and thickened lungs,46 patches in lungs,and 14 cases of nodular shadows.Other lesions: 2 cases of cystic translucent area,3 cases of calcification.4.Laboratory data analysis of infected and non-infected groups: Hb <90g/L,CRP,ESR,PCT,albumin <30g/L,urinary protein 3(+),DD,the difference was statistically significant(P < 0.05).5.Analysis of pre-hospital medications in SLE-infected patients and control patients: The prednisone dose ≥20 mg/d before admission(time exceeded one month)was statistically significant(P<0.05).6.In this study,of the 85 patients in the infection group,83 were cured after targeted anti-infective treatment and were discharged from the hospital.The remaining 2 patients died;of the 85 patients in the control group,80 were discharged from the hospital and 3 were treated in a superior hospital.It can be seen that the condition improved,and 2 cases gave up treatment due to economic reasons and were later lost to follow-up.Conclusion:1.SLE patients with lower respiratory tract and lung bacterial infection mostly occur in older patients(especially those aged ≥ 45 years)with a longer course of disease(the course of disease is more than 10 years).When SLE patients are ill,they usually have the characteristics of high disease activity,multiple organ involvement,poor nutritional status,and long-term use of moderate or higher doses of hormone.2.The pathogens of SLE patients with lower respiratory tract and lung infection are mainly gram-negative bacteria,and the proportion of multidrug-resistant bacteria is increased.3.The imaging changes of SLE patients with lower respiratory tract and pulmonary bacterial infection have no obvious particularity.HRCT examination should be performed in advance and compared with the previous imaging examination.4.PCT and CRP can provide valuable diagnostic clues for early diagnosis of lower respiratory tract and pulmonary bacterial infection.