系统性红斑狼疮患者合并COVID-19后发生肺炎的危险因素
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南昌大学第一附属医院风湿免疫科, 江西 南昌 330006

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吴锐  E-mail: tcmclinic@163.com

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国家自然科学基金(82260898)


Risk factors for the development of pneumonia after SARS-CoV-2 infection in patients with systemic lupus erythematosus
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Department of Rheumatology and Immunology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China

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    摘要:

    目的 探讨系统性红斑狼疮(SLE)患者感染新型冠状病毒(SARS-CoV-2)后发生肺炎的危险因素。 方法 纳入2022年12月—2023年2月于南昌大学第一附属医院风湿免疫科就诊且完善胸部CT检查并确诊为新型冠状病毒感染(COVID-19)的250例SLE患者。根据患者胸部CT结果分为对照组和肺炎组两组。收集两组患者的人口学数据、临床资料及实验室指标,并评估患者完善胸部CT检查之前的实验室资料。通过计算受试者工作特征(ROC)曲线,确定年龄、C反应蛋白/淋巴细胞(CLR)和系统性免疫炎症指数/清蛋白(SII/ALB)对SLE患者合并COVID-19后是否发生肺炎的诊断能力。 结果 250例SLE合并COVID-19患者中,188例未发生肺炎(占75.2%),为对照组;62例发生肺炎(占24.8%),为肺炎组。两组在年龄、是否接种新冠疫苗、是否合并肾功能不全、是否合并心血管疾病、是否合并糖尿病、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)、淋巴细胞/单核细胞(LMR)、系统性免疫炎症指数(SII)、SII/ALB和CLR等方面比较,差异有统计学意义(均P < 0.05)。在合并COVID-19后发生肺炎的SLE患者中,SII/ALB和CLR水平高于未发生肺炎患者,差异有统计学意义(均P < 0.05)。多因素logistic回归分析显示,年龄、SII/ALB和CLR是SLE患者发生新型冠状病毒肺炎的独立危险因素(均P < 0.05)。ROC曲线分析显示,CLR曲线下面积为0.791,其灵敏度为90.3%,特异度为57.4%,有良好的诊断价值。 结论 年龄、SII/ALB和CLR是SLE患者合并COVID-19后发生肺炎的危险因素。对于具备这些特征的人群,临床上需要给予更多的关注,以期减少并发症的发生及改善预后。

    Abstract:

    Objective To explore the risk factors for the development of pneumonia in patients with systemic lupus erythematosus (SLE) following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A total of 250 SLE patients who received chest CT examination and were diagnosed with COVID-19 at the Department of Rheumatology and Immunology in the First Affiliated Hospital of Nanchang University from December 2022 to February 2023 were included in analysis. Patient were divided into the control group and the pneumonia group according to chest CT results. Demographic data, clinical data, and laboratory indicators of patients in two groups of patients were collected. Laboratory data of patients before completing the chest CT examination were evaluated. Diagnostic capability of age, C-reactive protein/lymphocyte (CLR), and systemic immune inflammation index/albumin (SII/ALB) in evaluating the development of pneumonia in SLE patients with COVID-19 were determined by calculating the receiver operating characteristic (ROC) curve. Results Among 250 SLE patients with COVID-19, 188 (75.2%) didn't develop pneumonia and were assigned into the control group; 62 (24.8%) developed pneumonia in the pneumonia group. There were statistically significant differences between the two groups in terms of age, COVID-19 vaccination status, complications of renal insufficiency, cardiovascular disease or diabetes, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune inflammation index (SII), SII/albumin(SII/ALB) and C-reactive protein to lymphocyte ratio (CLR) (all P < 0.05). Among SLE patients who developed pneumonia after developing COVID-19, the levels of SII/ALB and CLR were higher than those of non-pneumonia patients, with statistically significant differences (both P < 0.05). Multivariate logistic regression analysis showed that age, SII/ALB, and CLR were independent risk factors for pneumonia in SLE patients with COVID-19 (all P < 0.05). ROC curve analysis showed the area under the CLR curve of 0.791, sensitivity of 90.3%, and specificity of 57.4%, with good diagnostic value. Conclusion Age, SII/ALB, and CLR are risk factors for pneumonia in SLE patients with COVID-19. More attention needs to be paid on populations with these characteristics in clinical practice, so as to reduce the occurrence of complications and improve prognosis.

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刘鹏程,张敏,李建斌,等.系统性红斑狼疮患者合并COVID-19后发生肺炎的危险因素[J]. 中国感染控制杂志,2023,(12):1468-1474. DOI:10.12138/j. issn.1671-9638.20234277.
Peng-cheng LIU, Min ZHANG, Jian-bin LI, et al. Risk factors for the development of pneumonia after SARS-CoV-2 infection in patients with systemic lupus erythematosus[J]. Chin J Infect Control, 2023,(12):1468-1474. DOI:10.12138/j. issn.1671-9638.20234277.

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  • 收稿日期:2023-03-29
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  • 在线发布日期: 2024-04-28
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