Invasive pulmonary fungal infections in patients with connective tissue disease: a retrospective study from northern China

Invasive pulmonary fungal infection (IPFI) is a potentially fatal complication in patients with connective tissue disease (CTD). The current study aimed to uncover the clinical characteristics and risk factors of patients with IPFI-CTD. The files of 2186 CTD patients admitted to a single center in northern China between January 2011 and December 2013 were retrospectively reviewed. A total of 47 CTD patients with IPFI were enrolled into this study and assigned to the CTD-IPFI group, while 47 uninfected CTD patients were assigned to the control group. Clinical manifestations were recorded, and risk factors of IPFI were calculated by stepwise logistical regression analysis. Forty-seven (2.15%) CTD patients developed IPFI. Systemic lupus erythematosus patients were responsible for the highest proportion (36.17%) of cases with IPFI. Candida albicans (72.3%) accounted for the most common fungal species. CTD-IPFI patients had significantly elevated white blood cell count, erythrocyte sedimentation rate, C-reactive protein and fasting glucose values compared to controls (P<0.05). Cough, sputum and blood in phlegm were the most common symptoms. Risk factors of IPFI in CTD included maximum prednisone dose ≥30 mg/day within 3 months prior to infection, anti-microbial drug therapy, and interstitial pneumonia. CTD patients who have underlying interstitial pneumonia, prior prednisone or multiple antibiotics, were more likely to develop IPFI.

侵袭性肺真菌病（Invasive Pulmonary Fungal Infection，IPFI）是结缔组织病（Connective Tissue Disease，CTD）患者潜在的致死性并发症。本研究旨在明确合并IPFI的CTD患者的临床特征与危险因素。本研究回顾性分析了2011年1月至2013年12月期间，中国北方某单中心收治的2186例CTD患者的临床资料。最终纳入47例确诊IPFI的CTD患者作为IPFI-CTD组，同时匹配47例未发生感染的CTD患者作为对照组。记录所有受试者的临床表现，并通过逐步logistic回归分析计算IPFI的危险因素。本队列中共计47例（2.15%）CTD患者发生IPFI，其中系统性红斑狼疮患者占比最高，达36.17%。白假丝酵母菌（Candida albicans）为最常见致病真菌，检出率为72.3%。与对照组相比，IPFI-CTD组患者的白细胞计数、红细胞沉降率、C反应蛋白及空腹血糖水平均显著升高（P<0.05）。咳嗽、咳痰及痰中带血为最常见的临床症状。CTD患者发生IPFI的危险因素包括感染前3个月内泼尼松日最大剂量≥30mg、抗菌药物治疗史及间质性肺炎。合并间质性肺炎、既往使用泼尼松或接受多种抗菌药物治疗的CTD患者，发生IPFI的风险显著升高。