Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus
Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus
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DOI：
10.1002/art.1780390906
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发表时间：
1996-09-01
影响因子：
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通讯作者：
Kahl, LE
中科院分区：
文献类型：
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作者：
Pryor, BD;Bologna, SG;Kahl, LE
目标。目的探讨系统性红斑狼疮(SLE)患者在环磷酰胺(CyC)联合大剂量糖皮质激素治疗过程中发生严重感染的危险因素。对100例接受环磷酰胺治疗的系统性红斑狼疮患者的记录进行检查，以了解在环磷酰胺治疗期间及随后的3个月内发生严重感染的记录。100例患者中有45例在环磷酰胺治疗期间发生感染。与未感染的患者相比，有感染的患者更容易发生多器官疾病(49%比29%；P=0.04)，白细胞计数的最低点(2,818比3,558个/亩L；P=0.02)，较高的皮质类固醇最大剂量(195比73毫克；P<或等于0.01)。在接受静脉(IV)(39%)或口服(40%)环磷酰胺的患者中，感染的发生率相同，但在使用顺序静脉注射和口服治疗(68%)的患者中更常见。多因素分析显示，白细胞最低值小于或等于3,000个/亩L(优势比[OR]2.8，95%可信区间[95%CI]1.4~5.5)和使用序贯静脉滴注和口服环磷酰胺(OR 2.3，95%CI 1.2~4.3)与感染的相关性最强。与大剂量类固醇治疗的患者相比，接受环磷酰胺联合类固醇治疗的患者感染发生率更高(45%比12%；P=0.001)。在环磷酰胺治疗期间，致命性和机会性感染与低WBC最低值和高最大皮质类固醇剂量有关。系统性红斑狼疮患者严重感染的风险受治疗方案中包括环磷酰胺的影响。在这种情况下，感染的可能性因环磷酰胺诱导的白细胞总数减少而增加
Objective. To determine risk factors for serious infection during treatment with cyclophosphamide (CYC) and high-dose corticosteroids in systemic lupus erythematosus (SLE).Methods. Records of 100 SLE patients who had received CYC were examined for documentation of serious infections that occurred during CYC therapy and the subsequent 3 months.Results. Infection occurred in 45 of 100 patients during CYC therapy. Patients with infection were more likely to have multiple organ disease (49% versus 29%; P = 0.04), a lower nadir in the white blood cell (WBC) count (2,818 versus 3,558 cells/mu l; P = 0.02), and a higher maximum corticosteroid dose (195 versus 73 mg; P less than or equal to 0.01) than patients without infection. Infection occurred with equal prevalence in those who received intravenous (IV) (39%) or oral (40%) CYC, but was more common with use of sequential IV and oral therapy (68%). By multivariate analysis, the strongest association with infection was a WBC nadir less than or equal to 3,000 cells/mu l (odds ratio [OR] 2.8, 95% confidence interval [95% CI] 1.4-5.5) and use of sequential IV and oral CYC (OR 2.3, 95% CI 1.2-4.3). Infection occurred in more CYC-treated patients taking concomitant steroids than in those treated with high-dose steroids alone (45% versus 12%; P = 0.001). Fatal and opportunistic infections during CYC therapy were associated with a low WBC nadir and a high maximum corticosteroid dose.Conclusion. The risk of serious infection in patients with SLE is influenced by the inclusion of CYC in the treatment regimen. The likelihood of infection in this setting is enhanced by CYC-induced reductions in the total WBC count