Clinical significance of fever in the systemic lupus erythematosus patient receiving steroid therapy
Clinical significance of fever in the systemic lupus erythematosus patient receiving steroid therapy
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DOI：
10.1111/j.1523-1755.2005.00453.x
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发表时间：
2005-08-01
影响因子：
19.6
通讯作者：
Hebert, LA
中科院分区：
文献类型：
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作者：
Rovin, BH;Tang, YX;Hebert, LA
背景。活动性系统性红斑狼疮 (SLE) 可引起发烧。类固醇（糖皮质激素）抑制系统性红斑狼疮发热；然而，类固醇治疗对 SLE 发热的影响程度此前尚未经过严格研究。研究 A 是一项针对复发性活动性 SLE 患者（N = 92、60 例肾性 SLE 和 32 例非肾性 SLE）的前瞻性研究，这些患者记录每日夜间口腔温度，同时参与 SLE 发作危险因素的纵向研究。研究 B 是一项对连续发热 SLE 患者 (N = 22) 进行的回顾性研究，这些患者最初因怀疑患有 SLE 而接受类固醇治疗。最终分析 11 例有 SLE 发热，11 例有感染发热。结果。在研究 A 中，在平均 13.2 +/- 8.1 个月的随访期间，92 名患者中有 51 名经历了 73 次 SLE 发作。只有一名患者出现与 SLE 发作相关的 SLE 发热。在其他 50 名发作的患者中，在 SLE 发作之前或发作时没有明显的发烧趋势。在宣布 SLE 发作的研究访视中，82% 的患者接受了泼尼松（中位剂量 10 毫克）治疗。在研究 B 中，泼尼松 28 mg（范围 20 至 40 mg）通常在 24 小时内完全抑制 SLE 发热。相比之下，尽管泼尼松 35 至 300 毫克/天，感染发烧仍然持续。在感染发热的患者中，当继续大剂量类固醇治疗时，三人出现致命的败血症。结论。在接受维持剂量或更大剂量泼尼松的 SLE 患者中，SLE 发热很少见。当发烧时，通常是由于感染。对感染发烧的患者继续使用高剂量类固醇治疗可能会增加严重败血症的风险。
Background. Active systemic lupus erythematosus (SLE) can cause fever. Steroids (glucocorticoids) suppress SLE fever; however, the extent to which steroid therapy affects SLE fever not previously been rigorously studied.Methods. Study A is a prospective study of recurrently active SLE patients (N = 92, 60 renal SLE and 32 nonrenal SLE) who recorded daily oral evening temperatures while participating in a longitudinal study of risk factors for SLE flare. Study B is a retrospective study of consecutive febrile SLE patients ( N = 22) who received steroids initially because SLE was suspected. At final analysis 11 had SLE fever and 11 had infection fever.Results. In study A during a mean follow-up of 13.2 +/- 8.1 months, 51 of the 92 patients experienced 73 SLE flares. In only one patient was SLE fever associated with SLE flare. In the other 50 patients who flared, there was no significant trend to develop fever prior to or at the onset of SLE flare. Prednisone, median dose 10 mg, was being received at 82% of the study visits at which an SLE flare was declared. In study B, prednisone 28 mg ( range 20 to 40 mg) completely suppressed SLE fever, usually within 24 hours. In contrast, infection fever persisted despite prednisone 35 to 300 mg/day. Of those with infection fever, three developed fatal sepsis when high-dose steroid therapy was continued.Conclusion. In SLE patients receiving prednisone at maintenance doses or greater, SLE fever is rare. When fever does develop, it is usually due to infection. Continuing high steroid dose steroid therapy in those with infection fever may increase the risk of severe sepsis.