Clinical Characteristics Analysis Of Pulmonary Infection In Patients Diagnosed As Nephrotic Syndrome With Glucocorticoid Therapy

Background Glucocorticoid has been widely used in nephrotic syndrome, connective tissue disease and acute or chronic inflammatory diseases as a result of its strong anti-inflammatory, antitoxic, resistance to shock and immune inhibitory functions. However, during the treatment and application of glucocorticoid it may lead to a series of side effects at the meanwhile, such as serious infections, osteoporosis, peptic ulcer, water-sodium retention, hypertension and so on. It is not rare that the infection especially pulmonary infection in patients with nephrotic syndrome who is offering the glucocorticoid therapy. In addition, low-status of our body's immune system is often complicated with severe infection. With the different clinical manifestations, imaging and pathogenic characteristics of general community-acquired pneumonia, it is unreasonable for physicians to deal with these patients fully depending on the basis of common treatment experience, diagnosis and treatment in CAP. Unfortunately, the relative guideline and researches are rather rare or lacking of the support of evidence-based medicine. All above may lead to the increased rate of delayed diagnosis or misdiagnosis in such infection conditions by clinicians especially the non-respiratory department clinicians as the poor experience and Low vigilance.ObjectiveTo explore the clinical manifestations and imaging characteristics of pulmonary infection in patients diagnosed as nephrotic syndrome with glucocorticoid therapy, and to improve the ability of clinical physicians in diagnosis and treatment of these kinds of diseases. Analyze the value of G and GM test in the diagnosis of pulmonary fungal infection, as well as the value of CRP and PCT and its relevance to the glucocorticoid application duration and dose in pulmonary infection under the long-term application of glucocorticoids.MethodsTo select the cases in the admission of the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2015, the cases has been diagnosed with nephrotic syndrome, with the therapy of glucocorticoid and companied with lung infection or showed an exacerbation of original lesion. we collected 54 patients totally, aged 17 to 78 years old,with the average age of(47±14.5), contained 40 male cases and 14 female cases.Analyze the duration, doses, and daily doses of GCs application. Get the statistics of the initial symptoms, imaging findings, total white blood cells, neutrophils ratio and erythrocyte sedimentation rate, C-reactive protein and G test, GM test, pathogens, treatment and outcome as the clinical characteristics. SPSS 18.0 software was used for the statistical analysis; quantitative data with the normal distribution were described by (?)±s, and were compared by t-test. Graph Pad Prism 6.0 was used for the statistical graphics, chi-square test was used for four squares table counting data. Correlation analysis was used for describing the degree of correlation between two variables, Pearson correlation analysis was applied for correlation of random variables which were linearly related; Spearman correlation analysis was applied for correlation of a rank correlation. Evaluation of the accuracy of the diagnostic methods was relied on the receiver-operating characteristic curve(ROC curve). Statistical significance defined as a P-value<0.05.Results54 cases were collected in this research, pulmonary infection occurred mostly in the early(11±7.39) weeks in the application of glucocorticoids, total doses showed the average age of(3325.33±1856.44) mg, similar to the mount of enough GCs use in 2months(3600 mg). The initial symptoms showed fever in 34 cases(62.97%), cough in 14 cases(25.92%), chest tightness in 4 cases(7.40%). About 11.11% of the infectious patients characterized by fever without other respiratory symptoms, what's more, there was 1 case without infectious clinical symptoms(1.85%). CAP accounted for 74.07%, HAP for 25.93%(14/54) of all infections(40/54), the proportion of severe pneumonia was 24.07%(13/54).83.33% of the cases occurred as inflammatory nodule lesions in CT images, 64.81% occurred as ground glass shadow, 57.41% showed patchy effusion shadows, consolidations were appeared in cases of 42.59%, and 27.78% in pleural effusion, 22.22% in cavities.The total effective rate in 54 cases is 79.63%, mortality of severe pneumonia is 46.15%(13 cases). Total positive rate of pathogens was 16.67%(9/54), including 44.44%(4/9) accounted for fungal pathogens, the total anti-fungal therapy patients accounted for 68.52%.It was concluded the following results from the statistical analysis: GCs duration and GM test were positively correlated(P = 0.049), GCs duration, total doses were negatively correlated with the occurrence of pleural effusion(P = 0.014). Numbers of white blood cells and neutrophils ratio between HAP and CAP showed no statistical significance(P > 0.05), ROC curve suggested the higher value of G test than GM test in the diagnosis of fungal infection(ROC=0.918 in G test vs 0.623 in GM test).ConclusionsPulmonary infection in patients with nephrotic syndrome with the application of glucocorticoids often shows the characters of atypical clinical symptoms and imaging findings. What's more, the mortality of severe pneumonia is very high, the same status in the incidence of fungal infection. G test has the higher diagnostic value than GM test in pulmonary fungal infection.