预运动干预对流感疫苗免疫应答效果的Meta分析

Meta⁃analysis of effect of pre⁃exercise intervention on immune response to influenza vaccine

目的Meta分析评价预运动对健康成年人流感疫苗(influenza vaccine,InfV)接种后免疫应答效果的影响,以期为InfV免疫应答的“运动佐剂”研究提供循证依据。方法检索PubMed数据库、Cochrane Library数据库、EMbase数据库、Web of Science数据库、中国知网(CNKI)数据库、万方数据知识服务平台(Wanfang)、中国生物医学文献服务系统(SinoMed),筛查预运动对成年人InfV免疫应答效果的随机对照试验(randomized controlled trial,RCT)研究文献。运用Cochrane偏倚风险评估工具进行文献质量评价,Stata 15.0软件进行Meta分析。结果共纳入21项预运动干预对InfV免疫应答效果的RCT研究,试验组包含702名受试者,对照组包含698名受试者;纳入研究存在风险偏倚的可能性较低。Meta分析显示,与对照组比较,预运动可显著提高成年人InfV接种后甲型H1N1[MD=0.47(95%CI:0.36~0.58),P<0.05]、甲型H3N2[MD=0.34(95%CI:0.21~0.47),P<0.05]、乙型[MD=0.34(95%CI:0.22~0.46),P<0.05]流感病毒抗体滴度及抗体血清保护率[OR=1.38(95%CI:1.20~1.56),P<0.05]。亚组分析结果表明,慢性预运动可显著提高成年人InfV接种后甲型H1N1[MD=0.72(95%CI:0.54~0.90),P<0.05]、甲型H3N2[MD=0.52(95%CI:0.15~1.09),P<0.05]、乙型[MD=0.81(95%CI:0.53~1.09),P<0.05]流感病毒抗体滴度及抗体血清保护率[OR=1.42(95%CI:1.22~1.62),P<0.05],急性预运动对InfV接种后甲型H3N2[MD=0.14(95%CI:0~0.29),P>0.05]、乙型[MD=0.22(95%CI:0.09~0.36),P>0.05]流感病毒抗体滴度的影响仍有待进一步验证;年龄可能是限制预运动对InfV接种后受试者流感病毒抗体滴度的因素。结论预运动干预可有效提高成年人InfV接种后的免疫应答效果。仍需后续高质量研究以明确改善InfV免疫应答效果的运动方案。

Objective To evaluate the effect of pre-exercise on immune response to influenza vaccine(InfV)in healthy adults by Meta-analysis,so as to provide evidence-based basis for the study of"exercise adjuvant"of InfV immune response.Methods PubMed,Cochrane Library,EMbase,Web of Science database,CNKI,Wanfang Data Knowledge Service Platform(Wanfang),and SinoMed were searched to screen the research literature of randomized controlled trials(RCTs)about the effect of pre-exercise on immune response to InfV in adults.Cochrane bias risk assessment tool was used to evaluate literature quality,and Stata 15.0 software was used for Meta-analysis.Results A total of 21 RCT studies on the effect of pre-exercise intervention on immune response to InfV were included,with 702 subjects in the experimental group and 698 subjects in the control group.There was a low probability of risk bias in the included studies.Meta-analysis showed that,compared with the control group,pre-exercise significantly increased the antibody titer and serum protection rate[OR=1.38(95%CI:1.20-1.56),P<0.05]of influenza virus A H1N1[MD=0.47(95%CI:0.36-0.58),P<0.05],influenza virus A H3N2[MD=0.34(95%CI:0.21-0.47),P<0.05],and influenza virus B[MD=0.34(95%CI:0.22-0.46),P<0.05]in adults after InfV vaccination.The results of subgroup analysis showed that chronic pre-exercise significantly increased the influenza virus antibody titer and serum protection rate[OR=1.42(95%CI:1.22-1.62),P<0.05]in adults after InfV vaccination,including influenza virus A H1N1[MD=0.72(95%CI:0.54-0.90),P<0.05],influenza virus A H3N2[MD=0.52(95%CI:0.15-1.09),P<0.05],and influenza virus B[MD=0.81(95%CI:0.53-1.09),P<0.05].The effect of acute preexercise on antibody titers of type A H3N2[MD=0.14(95%CI:0-0.29),P>0.05]and influenza virus B[MD=0.22(95%CI:0.09-0.36),P>0.05]after InfV vaccination still needs further verification.Age may be a factor limiting the titer of influenza virus antibodies in subjects receiving InfV vaccination after pre-exercise.Conclusion Pre-exercise intervention can effectively improve the immune response after InfV vaccination in adults.Follow-up high-quality studies are needed to identify exercise regimens that improve immune response to InfV.