实体器官移植受者接种三价流行性感冒灭活疫苗免疫原性Meta分析

Meta-Analysis of Immunogenicity of Trivalent Influenza Inactivated Vaccine in Solid Organ Transplantation Recipients

目的评价实体器官移植(Solid Organ Transplantation,SOT)受者接种三价流行性感冒灭活疫苗(Trivalent Influenza Inactivated Vaccine,TIV)的免疫原性。方法电子检索美国国家医学图书馆数据库(National Center for Biotechnology Information,NCBI)、Cochrane协作网图书馆、中国生物医学文献数据库(China Biology Medicine disc,CBMd)、中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)和万方全文数据库(Wanfang Database,WF),将有关评价SOT受者接种TIV免疫原性的前瞻性研究纳入分析。以接种1剂次TIV后针对A/H1N1、A/H3N2和B型3个疫苗株的短期血清抗体阳转率(Seroconversion Antibody Rate,SR)作为结局指标,使用Rev Man5.3软件合并所有研究的SR和对照设计研究的率差(Risk Difference,RD)。结果纳入21篇文献,有15篇为对照设计,余6篇为非对照设计。SOT受者接种TIV后针对A/H1N1、A/H3N2和B型疫苗株的SR分别为56%(95%CI:42%~70%)、55%(95%CI:43%~67%)和46%(95%CI:30%~63%);SOT受者与对照组接种TIV后各型疫苗株SR的RD分别为-18%(95%CI:-31%^-5%)、-18%(95%CI:-29%^-7%)和-13%(95%CI:-23%^-3%),其中成人SOT组与对照组各型疫苗株SR的RD分别为-14%(95%CI:-18%^-9%)、-23%(95%CI:-28%^-18%)和-20%(95%CI:-25%^-15%);肾移植受者与对照组各型疫苗株SR的RD分别为-21%(95%CI:-36%^-5%)、-16%(95%CI:-28%^-4%)和-9%(95%CI:-15%^-3%)。结论 SOT受者接种TIV后免疫应答低于普通人群,但接种TIV仍可使SOT受者获益,建议SOT受者及其医护人员、密切接触者、家庭成员每年接种TIV。

Objective To evaluate immunogenicity of trivalent influenza inactivated vaccine （TIV） in solid organ transplant （SOT） recipients. Methods We searched National Center for Biotechnology Infor- mation （NCBI）, Cochrane Library （CL）, China Biology Medicine disc （CBMd）, China National Knowledge Infrastructure （CNKI）, and Wanfang Database （WF） for prospective studies of evaluating immunogenicity of TIV in SOT recipients. Seroconversion antibody rates （SR） against A/H1N1, A/ H3 N2, and B3 strains were used as short-term endpoints. A pooled SR with 95 % CI was calculated for all included studies and a pooled Risk Difference （RD） with 95% CI was calculated for control studies, using the RevManS. 3 software for meta-analysis. Results Twenty one studies were included, of which 15 were control studies and 6 were non-control studies. The SRs of TIV against A/H1N1, A/H3N2 and B3 strains in SOT recipients were 56% （95% CI：42%-70% ）, 55% （95% CI：43%-67% ） and 46% （95%CI：30%-63%）, respectively. The RDs between SRs of TIV against 3 strains in SOT recipients and control group were -18% （95%CI： -31%--5%）, - 18% （95%CI： -29%--7%） and - 13% （95% CI： - 23%- - 3% ） , respectively; for adults, the RDs were - 14% （95% CI： - 18%--9%）, -23% （95%CI：-28%--18%） and - 20% （95% CI： - 25%-- 15%）, respe- ctively, and for renal SOT recipients, the RDs were -21% （95%CI： -36%- -5%）, -16% （95%CI： -28%- -4%） and -9% （95% CI： - 15%- -3%） , respectively. Conclusions The im- mune response against T1V in SOT recipients is lower than that in a healthy population, but TIV vaccina- tion still benefits SOT recipients. We suggest that SOT recipients, their medical care personnel, close contacts and family members receive TIV vaccination annually.