Research Of Severe Pneumonia In Autoimmune Disease Patients

BackgroundThe immunity of autoimmune disease (AID) patients is low because of abnormal autoimmunity and the treatment of glucocorticoids and immunosuppressive agents. Thus those patients easily develop with infection, and one of the most common infections is lung infection. Once AID patients get lung infection, they easily deteriorate to severe pneumonia, and the mortality is high. Therefore, those patients are paid wide attentions in clinical work. And, the differentiation of severe pneumonia characteristics between AID and immunodeficiency non-AID is not clear. So, our study compare with the two groups to know well the clinical and prognosis characteristics of AID with severe pneumonia patients.ObjectiveThe aim is to elevate the levels of diagnosis and treatment for AID patients developed with severe pneumonia, by exploring their clinical characteristics, diagnosis, therapy and prognosis. MethodsOur retrospective study included49severe pneumonia patients in AID from Jul-y2009to February2012in the Respiratory and Intensive care Unit of the First Affili-ated Hospital of Zhengzhou University, and40severe pneumonia cases in immuno-deficiency non-AID are contained, as control group. This study used the statistical methods to comparatively analyze the clinical manifestation, signs, inflammation marks, chest imaging findings, pathogen distribution, therapy and prognosis in the two groups, and compare the positive rate of the common sputum culture with the BALF culture.Result1. Clinical Characteristics In the AID group, the symptom of fever was more common than control group (P<0.05), and the cough and sputum were less (P<0.05). Breath sound weakened in the AID group was more common sign than control group (P<0.05), and the rale and rhonchi were less (P＜O.05).2. Imaging Findings Chest X-ray and lung CT scan presented diversity and changed quickly, and the image lesions commonly existed in different lung zones. In the AID group, ground glass shadow was more common than control group (P<0.05), while, the mass-like shadow was less (P<0.05).3. Infection Marks WBC、NEUT%、PCT and CRP were all abnormal, and the concentration of PCT meant severe infection. Comparing the two groups, CRP in the AID group was higher (P<0.05).4. Pathogens Distribution Bacterium was the main pathogen kind in the two groups, and in which Gram-negative bacillus was the most. Conditional pathogens in Gram-negative bacillus were common. Fungus infection in AID group was more common than control group (P<0.05). The culture of sputum was limited to find pathogenic bacteria, and the positive rate was43.1%. While BAL elevated the detective rate, the positive rate was69.6%, and there was significant difference (P＜O.05). 5. Treatment Results In the AID group:the rate of noninvasive mechanical ventilation was higher than control group (P<0.05), while the rate of invasive mechanical ventilation was lower (P<0.05). But, comparing the total rate of mechanical ventilation and the final invasive mechanical ventilation rate in two groups, there were no significant difference. In AID group,6cases were cured (12.3%),15cases were improved (30.6%), and28cases were invalid or death (57.1%). Comparing the invalid rate or mortality in two groups, the rate in AID group was higher, and there was significant difference (P<0.05).Conclusion1. Comparing with the immunodeficiency non-AID patients, the clinical characteristics and prognosis of severe pneumonia patients in AID are different. In AID group, fever is the most common infection symptom, while, the cough and sputum is less. And the rale and rhonchi signs are less too. The image manifestations present diversity and commonly exist in different lung zones.2. In AID group, Bacterium is the main pathogen, and fungus infection is too common. The bronchoalveolar lavage fluid culture positive rate is significantly higher than traditional sputum culture positive rate3. In AID group, CRP is significantly high. That means when the AID patients get infection, the inflammation reaction strengthen.4. In the AID group, the rate of the noninvasive mechanical ventilation is high. Although the ventilation changes to the invasive mechanical ventilation appropriately and promptly after the fail therapy of the noninvasive mechanical ventilation, the illness also develops quickly, and the invalid rate or mortality is high.