Analysis On Clinical Feature And Risk Factor Of Systemic Lupus Erythematosus Complicated With Severe Pneumonia

Objective Severe pneumonia is a serious disease of lung infection,with rapid progress and high mortality.We collect the cases of systemic lupus erythematosus complicated with severe pneumonia and analyze its clinical feature and risk factors to provide certain basis for disease prevention and early diagnosis and treatment.Methods A case-control study was conducted to collect the clinical data of 13 cases SLE with severe pneumonia in our hospital in the past five years.SLE with non-severe pneumonia in the same period was randomly included as the control group(52 cases).The demographic characteristics,organ involvement,laboratory and imaging data between the two groups were summarized.The clinical characteristics of SLE patients with severe pneumonia were analyzed,and the risk factors were further analyzed by single and multiple regression analysis.The ROC curve of independent risk factors was drawn and the optimal cutoff point of each index was obtained.All the data were analyzed by SPSS 20.0 software.Select P < 0.05 as statistical difference.Results 1.The average age of SLE-SP group was(49.7 +9.8)years,including 3 males and 10 females,3 cases complicated with interstitial pneumonia,5 cases with diabetes,7 cases with lupus nephritis,1 cases with cardiac insufficiency and lupus encephalopathy.Of all the patients,5 cases severe pneumonia occurring within one year of the course of SLE,5 cases course longer than 10 years,and the most frequent manifestations of lung CT in SLE-SP group were double lung multiple ground glass opacity.Pathogenic bacteria were detected in 11 cases,including 7 fungi(5 Candida albicans,1 Candida tropicalis,1 Aspergillus fumigatus),1 bacterium(Acinetobacter baumannii)and 3 cytomegalovirus.There are 3 cases patients with clinical diagnosis of pneumocystis pneumonia.Six of 13 patients in SLE-SP group died(46%).Among them,5 died of respiratory failure,1 of septic shock and 7 of them were discharged from hospital(54%).2.Univariate analysis showed significant differences in age,absolute lymphocyte value,CD4 + T cell count,B cell count,albumin,C-reactive protein,complement C4,procalcitonin and diabetes mellitus(P < 0.05).3.Multivariate logistic regression analysis showed that CD4 + T lymphocyte(OR=0.98,P=0.017)was an independent risk factor for SLE complicated with severe pneumonia,and C-reactive protein(OR=1.019,P=0.033)was an important inflammatory marker to identify severe infection.4.ROC curve analysis showed that SLE took a high risk of severe pneumonia when CD4 + T lymphocyte count was less than 248/u L.CRP > 58mg/L was of great significance in distinguishing severe infections.Conclusion 1.SLE complicated with severe pneumonia occurs more frequently within 1 year and more than 10 years after the onset of SLE.The positive rate of bacteria in sputum smears is low.Candida albicans is the most frequent pathogen detected,followed by cytomegalovirus.Pneumocystis pneumonia is not rarely.The clinical manifestations are not specific.The most frequent manifestations of lung CT are multiple double lungs ground glass opacity.2.SLE with severe pneumonia has a high mortality rate and poor prognosis.The decrease of CD4+T lymphocyte was independent risk factor for severe pneumonia in systemic lupus erythematosus and C-reactive protein was an crucial inflammatory marker to identify severe infection.