| Objective (s): To research the clinical epidemiological characteristics of Invasive fungal disease(IFD) in patients with Systemic lupus erythematosus (SLE) in our department.Provide evidence for the diagnosis and treatment of systemic lupus erythematosus.Methods: 1. A total of 406 hospitalized patients with systemic lupus erythematosus in our hospital from October 2014 to December 2016 were analyzed , screening of 19 patients with invasive fungal disease,at the same time,60 patients without invasive fungal disease were selected as control group. 2.According to the related literature at domestic and abroad, as well as the characteristics of our department, we design a questionnaire which can meet the clinical needs of our department: Hospital number,gender,nationality,age,disease duration, hospitalization duration,SLEDAI score,underlying diseases, complications, suspected infection symptoms / signs, the use of glucocorticoids, the use of immunosuppressants, the use of antibiotics, invasive operation, white blood cell count, lymphocyte count, albumin, CRP, complement C3,complement C4, ANA, ANCA etc( Reference Appendix). 3.20 strains of pathogenic fungi were isolated from the patients with invasive fungal disease, carry out its identification and drug sensitivity test. 4. Statistical analysis was performed using SPSS 17.0 statistical software package.Results: 1. During the October 2014 to December 2016, there were 19 patients with SLE complicated with IFD in our department, and the control group of 60 cases.Hospitalization days of positive group and control group were 14.84±7,01 days and 11.60±5.06 days. The most age groups were 41-60 years old (56.25%) and 21-40 years(50%),there were statistical differences(P<0.05). There was no significant difference in the duration of disease, gender and nationality (P>0.05).2. The source of the bacteria,63.16% (n = 12) were from sputum, and there were 21.05% (n = 4) from feces, and there were (2) cases from urine, sputum and urine accounted for 5.26% (n = 1).3. Fungi were isolated from 19 patients with SLE combined with IFD, and the results of identified: 11 strains of Candida albicans (55%), 3 strains of Candida parapsilosis(15%), 2 strains of Candida glabrata (10%), 2 strains of Candida tropicalis (10%),2 strains (10%:1 strain of candida dubliniensis, 1 strains of Candida sake).4. The results of single factor analysis: SLEDAI score, Glucocorticoid dosage, Glucocorticoid treatment course, complications, bacterial infection or suspected infection symptoms,the use of immunosuppressive agents and the use of antibiotics, antibiotic use is more than 2, invasive operation, decreased white blood cell count, lymphocyte count decreased, CRP increased, C3 decreased complement, these factors are associated with SLE secondary IFD (P<0.05). Logistic regression analysis finally found 5 independent factors, according to the OR value from large to small, followed by SLEDAI score, use of corticosteroids, use of antibiotics, use of immunosuppressants, invasive operation.5.In vitro drug sensitivity test: All strains were sensitive to 5-FC and AMB; There were 1 cases of Candida albicans intermediary to FCA and ITR. sensitivity was 90.91 %, the drug resistance rate of VRC was 9.09%; The sensitivity of Candida parapsilosis to FCA and ITR was 100%, and the sensitivity to VRC was about 66.67%; The sensitivity of Candida glabrata to FCA and VRC was 100%, and the sensitivity to ITR was about 50%; Candida tropicalis was sensitive to FCA, ITR and VRC.6. The effective rate was 100% in patients with SLE combined with IFD, there were 4 patients with complete remission and 15 patients with partial remission. Happen repeatedly invasive fungal infection occurred up to 7 cases within 1 year, and the recurrence rate of 36.84%.Conclusion(s): 1. The incidence of SLE associated with IFD was 4.68% in our department, and the trands rised;2. There were 14 factors related to the occurrence of SLE combined with IFD, 5 independent risk factors were found by Logistic regression analysis: SLEDAI score, use of corticosteroids, use of antibiotics, use of immunosuppressants, invasive operation;3. The mainly Infection site of SLE combined with IFD was respiratory tract, gastrointestinal tract and urinary tract;4. The distribution of Candida albicans was still dominant, but the proportion declined; 5. All strains were sensitive to 5-FC and AMB, resistance to azoles was lower than that in other reports,only partial resistance to Itraconazole and voriconazole.6. The effective rate of SLE combined with IFD in our department was 100%, and the recurrence rate was 36.84%. |
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