【Cochrane简语概要】哮喘患者预防流感的疫苗

哮喘是一种影响呼吸道的疾病，呼吸道即空气进出肺部的小管道，而哮喘症状通常是咳嗽、喘息、呼吸急促和胸闷。这些症状可以是偶发性的也可以是持续性的。当哮喘患者吸入哮喘诱发因素（刺激呼吸道的异物）时，气道内壁肌肉收紧，使气道变窄，气道内壁发炎并开始水肿。对于许多哮喘患者而言，感冒和流感病毒会诱发他们的这些症状。因此，感染流感病毒会使他们的哮喘恶化，而接种流感疫苗可以保护人们免受某些病毒侵害，这些病毒通常会在冬天与人接触。然而，流感疫苗（疫苗接种）的效用并不是简单直接的，因为流感疫苗本身也可能导致哮喘的恶化。英国现有的指南建议，高危人群如严重哮喘患者，每年冬天都要接种流感疫苗（NHS Choices）；然而，这种方法的证据有限。

（图片来源于网络）

在本综述中，我们评价了成人和儿童（2岁以上）哮喘患者接种各类流感疫苗的潜在好处与风险的随机对照试验 （RCTs） 中的证据。

一项涉及696名儿童的试验评价了注射灭活流感疫苗的好处（灭活疫苗是美国和英国目前使用且不会引起流感的一类疫苗）。哮喘发作（症状恶化）的人数没有显著差异；然而，在儿童流感抗体测试阳性人群中症状评分较好（报告哮喘症状较轻），即接种人群比未接种人群好。

两项试验包含1526名成人和712名儿童中，受试者接种了灭活流感疫苗，并在注射后当即评估了接种造成的有害影响。这些研究排除了在接种流感疫苗之后的头两周内，100名患者中有超过4人哮喘发作的可能性。没有足够的信息来比较不同类型的疫苗。

结论: 

疫苗接种对与流感感染有关的哮喘恶化的保护程度仍不确定。最近公布的灭活分离病毒流感疫苗随机试验的证据表明，在成人或三岁以上儿童接种疫苗后，哮喘恶化情况没有立即显著增加。我们无法解答有关给予婴儿鼻内活疫苗是否可能增加喘息和住院情况的问题。

译者：江月；审校： 乔舒昱、鲁春丽；编辑排版：张晓雯，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Vaccines for preventing flu in people with asthma

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs - and the symptoms are generally coughing, wheezing, shortness of breath and chest tightness. The symptoms can be occasional or persistent. When a person with asthma breathes in an asthma trigger (something that irritates their airways), the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. For many people with asthma, cold and flu viruses trigger their symptoms. Therefore, getting a flu virus makes their asthma worse and having a flu jab (influenza vaccine) may protect people against some of the flu viruses that they will come into contact with in a given winter. However, the effects of a flu jab (vaccination) are not straightforward as there is also the possibility that the flu jab itself could cause a worsening of asthma. Current guidelines in the UK recommend that high-risk groups such as people with severe asthma should have a flu jab each winter (NHS Choices); however, there is limited evidence for this approach.

In this review, we evaluated evidence from randomised trials (RCTs) in relation to potential benefits and harms of all types of influenza vaccination in adults and children (over the age of two years) with asthma.

One trial in 696 children assessed the benefits of injecting inactivated influenza vaccine (inactivated virus vaccines are the type currently used in the US and UK and cannot cause flu). There were no significant differences in the number of people experiencing an asthma attack (worsening of symptoms); however, there were better symptom scores (people reporting fewer asthma symptoms) in weeks in which children had a positive test for influenza, in those who had received the jab compared to those who did not.

Two trials involved 1526 adults and 712 children who were given inactivated influenza vaccination, examined the harmful effects caused immediately after injection. These studies ruled out the likelihood of any more than four out of 100 people having a resultant asthma attack in the first two weeks after getting their flu jab. There was not enough information to compare different vaccination types.

Authors' conclusions: 

Uncertainty remains about the degree of protection that vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from more recently published randomised trials of inactivated split-virus influenza vaccination indicates that there is no significant increase in asthma exacerbations immediately after vaccination in adults or children over three years of age. We were unable to address concerns regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination.

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