[Opportunistic infection in systemic lupus erythematosus patients: the disease spectrum and the characteristics of peripheral lymphocyte subsets].

Objective: To investigate the common opportunistic infections and the characteristics of peripheral lymphocyte subsets in patients with systemic lupus erythematosus (SLE). Methods: From December 2013 to December 2016, peripheral lymphocyte subsets were consecutively detected by flow cytometry in treated SLE patients with or without opportunistic infections (OIs) . The lymphocyte subsets in healthy donors were used as normal control group. Results: A total of 145 treated SLE patients were enrolled including 108 with OIs and 37 without OIs. The common OIs were cytomegalovirus (CMV) diseases (66/108), Pneumocystis jirovecii pneumonia (PJP, 16/108), other fungal infections (16/108), Epstein-Barr virus (EBV, 15/108) and tuberculosis (14/108). Compared with treated SLE without OIs, total lymphocyte, CD(4+) T, and CD(8+) T lymphocyte counts were significantly reduced in SLE with OIs [1 260 (780, 1 810) cells/μl vs. 565 (399, 1 043) cells/μl, P<0.001; 485 (280, 811) cells/μl vs. 173 (95, 327) cells/μl, P<0.001; 464 (339, 764) cells/μl vs. 265 (158, 424) cells/μl, P=0.003, respectively]. Conclusions: The common OIs in treated SLE patients were CMV diseases, PJP, other fungi, EBV and tuberculosis. OIs are prone to develop in SLE patients with severe lymphocytopenia, especially CD(4+) T cell depletion.目的： 探讨系统性红斑狼疮（SLE）患者合并机会性感染的临床疾病谱以及外周血淋巴细胞亚群变化特点。 方法： 回顾性分析2013年12月至2016年12月北京协和医院住院收治的符合美国风湿病学会SLE诊断标准，糖皮质激素及免疫抑制治疗后且完成外周血淋巴细胞亚群检测患者的临床资料，分为SLE合并机会性感染组（108例）及SLE未合并感染组（37例）。同时收集健康正常人外周血淋巴细胞亚群检测值作为对照。 结果： 108例SLE合并机会性感染患者中巨细胞病毒（CMV）病（66例），耶氏肺孢子菌肺炎（16例），其他真菌感染（16例），EB病毒感染（15例）以及结核感染（14例）。与SLE未合并感染组相比，合并机会性感染组的淋巴细胞计数[1 260（780，1 810）个/μl比565（399，1 043）个/μl，P<0.001]、CD(4+)T细胞计数[485（280，811）个/μl比173（95，327）个/μl，P<0.001]、CD(8+)T细胞计数[464（339，764）个/μl比265（158，424）个/μl，P=0.003]更低。 结论： 本组SLE患者常见的机会性感染为CMV病、耶氏肺孢子菌肺炎等。SLE患者的免疫抑制治疗过程中，需要时刻平衡原发病治疗与机会性感染发生的关系，当出现淋巴细胞，尤其CD(4+)T细胞严重减少时需要高度警惕机会性感染发生。.