23价肺炎球菌多糖疫苗对慢性阻塞性肺疾病影响的meta分析

Effect of 23-valent pneumococcal polysaccharide vaccine on chronic obstructive pulmonary disease:a meta-analysis

目的系统评价23价肺炎球菌多糖疫苗应用于慢性阻塞性肺疾病(COPD)患者的效果,为开展COPD患者干预提供依据。方法检索Pubmed、EBSCO host、EM base、SpringerLink、Science Direct数据库、万方学术会议论文全文数据库、维普中文期刊数据库、中国知网CNKI数据库中,关于23价肺炎球菌多糖疫苗应用于COPD患者的随机对照试验(RCT)研究,检索时间为1995年1月—2017年12月,按照纳入与排除标准选择文献、评价文献质量和提取资料,之后应用RevMan 5.3软件进行meta分析。结果共纳入10个RCT。其中有4个RCT研究表明23价肺炎球菌多糖疫苗可以降低COPD患者的肺炎感染率(RR=0.68,95%CI=0.48~0.95,P<0.05),经敏感性分析,23价肺炎球菌多糖疫苗对肺炎感染率的meta分析结果不稳定;有3个研究表明23价肺炎球菌多糖疫苗可以缩短COPD患者的两次感染相距时间(WMD=87.68,95%CI=74.69~100.67,P<0.01);有6个研究表明23价肺炎球菌多糖疫苗可以缩短COPD患者住院天数(WMD=-5.95,95%CI=-7.46^-4.44,P<0.01);有6个研究表明23价肺炎球菌多糖疫苗可以降低COPD患者死亡率(RR=0.28,95%CI=0.17~0.47,P<0.01)。结论接种23价肺炎球菌多糖疫苗对于降低COPD患者的死亡率、缩短两次感染相距时间、减少住院天数有积极作用;但是对于降低COPD患者肺炎感染率研究结果不稳定,仍需更多证据支持。

Objective To evaluate the effect of 23-valent pneumococcal polysaccharide vaccine on patients with chronic obstructive pulmonary disease(COPD),provide evidence for the intervention of COPD patients.Methods The randomized controlled tri als(RCT)of 23-valent pneumococcal polysaccharide vaccine in patients with COPD,which were published from January 1995 to December 2017,were searched from Pubmed,EBSCO host,EM base,SpringerLink,Science Direct,Wanfang Database,VIP Database and CNKI Database.RCTs were selected and appraised according to the inclusion and exclusion criteria,the data were extracted,and the meta-analysis was conducted by RevMan 5.3 software.Results 10 RCTs were included in study.4 studies showed that23-valent pneumococcal polysaccharide vaccine could reduced the pneumonia infection rate in COPD patients[RR=0.68,95%CI=0.48-0.95,P<0.05).The sensitivity analysis showed that the meta-analysis results of 23-valent pneumococcal polysaccharide vaccine on the infection rate of pneumonia were not stable.3 studies showed that 23-valent pneumococcal polysaccharide vaccine could shorten the time between two infections in patients with COPD(WMD=87.68,95%CI=74.69-100.67,P<0.01).6 studies showed that 23-valent pneumococcal polysaccharide vaccine could shorten the length of hospital stay in COPD patients(WMD=-5.95,95%CI=-7.46--4.44,P<0.01).6 studies showed that 23-valent pneumococcal polysaccharide vaccine could reduce the mortality of patients with COPD(RR=0.28,95%CI=0.17-0.47,P<0.01).Conclusion 23-valent pneumococcal polysaccharide vaccine can reduce mortality,shorten the time between two infections,and shorten the length of hospital stay in patients with COPD.However,results of 23-valent pneumococcal polysaccharide vaccine reduce pneumonia infection rate in COPD patients are unstable and need further evidence support.