2014 — 2024年系统性红斑狼疮患者感染的时间趋势与临床特征分析

Temporal trends and clinical characteristics of infections in patients with systemic lupus erythematosus from 2014 to 2024

  • 摘要: 背景 各种病原体感染是系统性红斑狼疮(systemic lupus erythematosus,SLE)患者死亡的主要原因。然而,关于SLE患者感染的长期流行趋势、季节性模式、空间分布特征尚不明确。目的 分析SLE队列的感染流行病学特征,评估时空分布规律,并比较发生感染与未发生感染患者的临床特征差异。方法 本研究回顾性收集2014 年1 月至2024 年8 月于解放军总医院就诊SLE患者的信息。感染的判定依据医院电子病历系统,符合以下任一标准者定义为感染:明确的ICD-9 或ICD-10 感染性疾病诊断编码、微生物培养阳性,或开始新的全身性抗感染治疗。根据是否发生感染,将患者分为感染组和非感染组。应用卡方检验、局部加权回归平滑(locally estimated scatterplot smoothing,LOESS)曲线等统计学方法评估感染率的年度趋势、季节性分布,并比较不同时期的差异。比较感染组与非感染组在人口学特征、实验室检查及治疗方案上的差异,总结感染患者的临床特征。结果 共纳入5 839 例患者,女性5 081 例(87.0%),男性758 例(13.0%),中位年龄为3737(27,49) vs 35(25,50)岁。其中1 851 例(31.7%)发生了感染,感染组与未感染患者相比表现出更高的疾病活动度、更频繁的关键脏器受累、更严重的炎症反应以及更强的免疫抑制治疗背景(P均<0.05)。时间维度上,感染率在2014 — 2024 年呈现显著的持续下降趋势(P<0.001)。感染存在显著的季节性特征,表现为冬季高发(35.6%,P=0.004),夏季最低(29.3%,P=0.034)。与2019 年12 月前相比,2020 年1 月— 2022 年12 月和2023 年1 月及以后的总感染率均呈阶梯式显著下降(44.5% vs 24.3%和22.0%,P<0.001)。结论 2014 — 2024 年,SLE患者的感染负担呈现显著下降趋势,且存在明显的冬季高发性。感染患者表现出更为严重的疾病活动及免疫紊乱状态。这些发现为临床针对SLE患者制定季节性监测策略及识别高危人群特征提供了重要依据,以期最终降低与感染相关的不良事件发生率和病死率,改善患者的预后。

     

    Abstract: Background Infection by various pathogens is a leading cause of mortality in patients with systemic lupus erythematosus (SLE). However, the long-term epidemiological trends, seasonal patterns, and clinical characteristics of infections in SLE patients remain unclear and warrant further investigation. Objective To analyze the epidemiological characteristics of infections in SLE cohort, evaluate their spatiotemporal distribution patterns, and compare the clinical features between patients with and without infections. Methods This retrospective study collected data from patients with SLE who attended Chinese PLA General Hospital from January 2014 to August 2024. Infection was identified based on the hospital electronic medical record system and was defined by the presence of any of the following: a documented ICD-9 or ICD-10 diagnostic code for an infectious disease, a positive microbiological culture, or initiation of a new systemic anti-infective treatment. Patients were classified into infection group and non-infection group according to whether infection occurred. Chi-square tests, locally estimated scatterplot smoothing (LOESS) curves, and other statistical methods were used to assess annual trends and seasonal patterns in infection rates and to compare differences across periods. Demographic characteristics, laboratory findings, and treatment regimens were compared between the two groups to summarize the clinical features of infected patients. Results A total of 5 839 patients were included, including 5 081 women (87.0%) and 758 men (13.0%), with a median age of 37 (3727,49 vs 3525,50) years. Among them, 1 851 patients (31.7%) developed infection. Compared with non-infected patients, those with infection had higher disease activity, more frequent major organ involvement, more severe inflammatory responses, and stronger background of immunosuppressive therapy (all P<0.05). The infection rate showed significant and sustained downward trend from 2014 to 2024 (P<0.001). Infection also showed a significant seasonal pattern, with the highest rate in winter (35.6%, P=0.004) and the lowest in summer (29.3%, P=0.034). Compared with the period before December 2019, the overall infection rate decreased markedly from January 2020 to December 2022 and from January 2023 onward (44.5% vs 24.3% and 22.0%, respectively; P<0.001). Conclusion From 2014 to 2024, the infection burden in patients with SLE showed significant downward trend, with clear winter predominance. Patients with infection exhibit more severe disease activity and greater immune dysregulation. These findings provide important evidence for developing season-specific surveillance strategies and identifying high-risk clinical profiles in patients with SLE, with the ultimate goal of reducing infectionrelate adverse events and mortality and improving patient outcomes.

     

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