急性播散性脑脊髓炎与接种狂犬病疫苗关系的国内文献分析

Review on domestic published papers regarding the acute disseminated encephalomyelitis and its relations with rabies vaccination

探讨急性播散性脑脊髓炎（ADEM）发病与接种狂犬病疫苗的关联性。以关键词“急性播散性脑脊髓炎／脑炎／脊髓炎”检索1995--2011年中国期刊全文数据库、国家科技图书馆文献中心数据库的国内文献，搜索到符合分析条件的文献99篇，报道ADEM病例1368例，将病例及观察人群以是否接种狂犬病疫苗为暴露因素分为两队列进行队列研究，分析接种疫苗与ADEM发病关系。1995-2010年文献报道病例地区接种狂犬病疫苗人群ADEM标化发病率为9．41／100万人年，高于无接种人群标化发病率0．29／100万人年（u=428．35，P〈0．01），RR=31．05（95％CI：26．33～36．62），且RR值随狂犬病疫苗接种针次增加而增大。文献分析结果显示，接种狂犬病疫苗与ADEM发病存在高度关联。

To explore whether the case of acute disseminated encephalomyelitis （ADEM） who had been inoculated with rabies vaccination reported in domestic literatures were related to the vaccination. Data on 1368 cases of ADEM （from 99 papers） were collected by computer from the Chinese Journal Full-text Database in CNKI and Wanfang database with the key words of acute disseminated encephalomyelitis/rabies vaccination/abnormal reaction in preventive vaccination during 1995 and 2011. All the cases were divided into the two queues according to the situation of rabies vaccination. Cohort study was used to analyze the relations between ADEM and vaccination. The incidence of ADEM, standardized by age that having received immunization with rabies vaccine, was 9.41/1 million person year, higher than 0.29/1 million person year （u=428.35, P〈0.01 ） among those who had not. Among people who had been inoculated, the adjusted RR value of cause ADEM was 31.05 （95% CI. 26.33-36.62）. RR values increased along with the times of rabies vaccine injection. Correlation was seen between inoculated rabies vaccine and ADEM.