The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients
The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients
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系统性红斑狼疮发热的原因及临床意义：487例住院患者的回顾性研究
DOI：
10.1177/0961203309103870
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发表时间：
2009-08-01
期刊：
影响因子：
2.6
通讯作者：
Yang, C. D.
中科院分区：
文献类型：
--
作者：
Zhou, W. J.;Yang, C. D.
系统性红斑狼疮（SLE）发热的病因复杂。SLE发热的鉴别诊断对于这些患者的最佳管理至关重要。为了更好地了解SLE发热的原因和特点，回顾了2002年1月至2007年5月因SLE住院的1949例连续患者的病历。共确定并回顾性分析了487例SLE住院发热患者。其中感染性发热265例，SLE相关发热206例，SLE活动性和感染性发热8例，恶性肿瘤发热4例，其他原因发热4例。最常见的感染部位为呼吸道（62.6%）、泌尿道（8.6%）、皮肤和粘膜（8.3%）。强的松≤100 mg/d可使80.6%的SLE发热患者在1-5天内消退。与感染性发热患者相比，SLE发热患者更可能具有较低的血清补体C3和较高的SLE疾病活动指数评分。发现感染性发热与过去6个月内使用硫唑嘌呤有关。总之，感染和疾病活动是SLE发热的最常见原因。高剂量类固醇不能抑制SLE发热的患者通常有严重的狼疮脑病或噬血细胞综合征。
The causes of fever in systemic lupus erythematosus (SLE) are complicated. Differential diagnosis of fever in SLE is crucial for optimal management of these patients. To better understand the causes and characteristics of fever in SLE, the medical records of 1949 consecutive patients hospitalised for SLE from January 2002 to May 2007 were reviewed. A total of 487 SLE-hospitalised patients with fever were identified and retrospectively analysed. Among them, 265 patients had fever from infection, 206 had fever related to SLE, 8 had fever caused by both SLE activity and infections, 4 had fever caused by malignancies and 4 had fever ascribed to miscellaneous causes. The most common sites of infection were the respiratory tract (62.6%), urinary tract (8.6%), skin and mucosa (8.3%). A prednisone dose of ≤100 mg/d was able to suppress SLE fever in 80.6% of the patients, usually within 1–5 days. Compared to patients with infection fever, those with SLE fever were more likely to have lower serum complement C3 and a higher SLE Disease Activity Index score. Infection fever was found to be associated with the use of azathioprine within the last six months. In conclusion, infection and disease activity are the most common causes of fever in SLE. Those patients for whom SLE fever could not be suppressed by a higher dose of steroids usually had severe lupus encephalopathy or hemophagocytic syndrome.