在患有ANCA相关血管炎的患者中感染的特征和危险因素:系统性审查和元分析
Wenxuan Luo1, Can Liu1, Lei Zhang2
1Department of Rheumatology and Immunology, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Autoimmunity reviews
|December 1, 2024
概括
在抗中性粒细胞质抗体相关血管炎 (AAV) 中,感染很常见,影响超过一半的患者. 识别和管理风险因素,如特定药物和并发症,对于患者护理至关重要.
科学领域:
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
- 临床流行病学临床流行病学
背景情况:
- 抗中性细胞质抗体相关性血管炎 (AAV) 是一组自身免疫性疾病,其特征是小血管的炎症.
- 感染是AAV患者患病和死亡的重要来源,常常因免疫抑制疗法而恶化.
研究的目的:
- 综合审查特征并确定与被诊断为AAV的患者感染相关的关键风险因素.
- 综合目前关于AAV感染流行率和相关风险因素的证据.
主要方法:
- 在PubMed,Embase和Cochrane图书馆数据库中进行了系统的文献搜索,直到2023年11月.
- 使用元分析技术,使用随机效应模型将流行率,赔率比率和平均差异结合起来.
- 进行了敏感性和子组分析,以评估研究结果的可靠性.
主要成果:
- 任何感染的综合流行率为54.6%,严重感染发生在41项研究中的5343名AAV患者中的35.8%.
- 常见的感染部位包括呼吸系统,血液和尿道,发现了Pneumocystis jirovecii和Aspergillus等特定的病原体.
- 风险因素包括老年,末期病,糖尿病,吸烟,特定的AAV疾病参与,炎症标志物升高,以及使用免疫抑制疗法,如环胺和高剂量葡萄糖皮质激素.
结论:
- 在AAV的治疗策略必须主动考虑已识别的感染风险因素.
- 应解决可修改的风险因素,临床医生应警常见的感染和病原体.
- 建议对危及生命的感染进行经验性治疗,以常见病原体为指导.
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