【Cochrane简语概要】慢性阻塞性肺病的流感疫苗使用

问题 

流感疫苗使用能否减少慢阻肺患者的呼吸系统疾病发病和死亡？

研究背景 

慢性阻塞性肺病涵盖了进展性的肺部疾病，包括肺气肿、慢性支气管炎以及难治性（非可逆性的）哮喘。该疾病的特点是进行性的呼吸困难加重。尽管普遍建议慢性阻塞性肺病患者每年接种流感疫苗，但是很少有随机对照试验（一些相似的人被随机分配到两组（或更多组），以测试一种特定的药物、治疗或其他干预措施的研究）评估了治疗的效果。流感疫苗可以使用灭活病毒（病毒壁的小颗粒）或者减毒病毒（减弱的活性病毒）。

为了回答我们的问题，我们对来自世界各地的研究进行了详细的检索，这些研究调查了慢性阻塞性肺病患者使用流感疫苗的情况。

（图片来源于网络）

研究特征 

我们纳入了6项研究，共2469名慢性阻塞性肺病受试者参与，而另外5项研究，共4281名老年或高危受试者参与，其中一部分患有慢性肺病。

主要结果 

我们发现了一些中等质量的证据，证明灭活的流感疫苗确实能减少慢性阻塞性肺病的“爆发”，尤其是那些与流感病毒感染有关的疾病加重。灭活的病毒疫苗在肌肉中注射，与注射部位局部副作用（如疼痛）的增加有关，这些副作用是短暂的。灭活的病毒疫苗不会引起流感，也不会导致慢性阻塞性肺病的显著加重。在灭活病毒中加入减毒活病毒并不能为参与者提供更多保护。

证据质量 

这些证据质量中等。从2004年后就没有更多相关试验。我们在2017年12月进行了最后一次文献检索。

结论: 

显然，从我们纳入的有限的随机对照研究来看，这些随机对照研究都有十多年的历史，灭活疫苗似乎可以减少慢性阻塞性肺病患者的病情恶化。效应的大小与大型观察性研究相似，并且是由于接种疫苗后三周或更长时间内由于流感引起的病情恶化减少。接种疫苗后短暂的局部不良反应有轻微增加，但没有证据表明会引起早期症状加重。在灭活疫苗中加入减毒活病毒并没有显示出额外的获益。

译者：徐金鹏，东阳市人民医院；审校：杨鸣，北京中医药大学循证医学中心；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】Influenza vaccine for people with chronic obstructive pulmonary disease (COPD)

Question

Do influenza vaccines reduce episodes of respiratory illness or death in people with chronic obstructive pulmonary disease (COPD)?

Background

COPD is an umbrella term used to describe progressive lung diseases, including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. The disease is characterized by increasing breathlessness. Despite the almost universal recommendation that people with COPD should receive an annual influenza vaccination, very few randomised controlled trials (studies in which a number of similar people are randomly assigned to two (or more) groups to test a specific drug, treatment or other intervention) have evaluated the effect of this treatment. Influenza vaccines may be produced with an inactivated virus (small particles of the virus wall) or live attenuated virus (reduced power but still alive). 

To try to answer our question, we conducted a detailed search for studies from around the world that investigated the use of influenza vaccines for people with COPD.

Study characteristics 

We included six studies with 2469 participants with COPD, and a further five studies with 4281 older or high risk participants, a proportion of whom had chronic lung disease. 

Key resuIts

We found some moderate-quality evidence that inactivated influenza vaccine did decrease 'flare ups' of COPD, especially those that are related to the influenza virus itself. The inactivated influenza virus vaccine was given as an injection in the muscle, and was associated with an increase in local side effects (such as pain) at the site of injection, which were short-lived. The inactivated virus vaccine did not cause influenza, or any significant worsening of COPD. Adding a live attenuated virus to the inactivated virus did not add any further protection for the participants.

Quality of the evidence 

The evidence was of moderate quality. There have been no new trials since 2004. We conducted the last literature search in December 2017.

Authors' conclusions: 

It appeared, from the limited number of RCTs we were able to include, all of which were more than a decade old, that inactivated vaccine reduced exacerbations in people with COPD. The size of effect was similar to that seen in large observational studies, and was due to a reduction in exacerbations occurring three or more weeks after vaccination, and due to influenza. There was a mild increase in transient local adverse effects with vaccination, but no evidence of an increase in early exacerbations. Addition of live attenuated virus to the inactivated vaccine was not shown to confer additional benefit.

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