目的

        评估流感疫苗和肺炎球菌疫苗在狼疮患者中的免疫原性及其对疾病活动的影响

方法

        该研究对狼疮患者和正常人群接种23价肺炎疫苗和流感疫苗(AH1N1, AH3N2 and B strains) 的免疫反应进行系统性文献回顾和荟萃分析，评估接种前及接种3-6周后的血清保护率，并在疫苗接种前及接种后3-8周对狼疮患者进行SLEADAI评分对比。

结果

        该荟萃分析共囊括二十项研究，3项关于肺炎球菌疫苗、17项关于流感病毒疫苗，共对1665名SLE患者和826名健康人进行对照研究。接种肺炎球菌疫苗的SLE患者及正常人群，血清转阴率差异无显著性，SLEDAI评分亦无改变。关于流感疫苗的接种，SLE患者对H1N1流感疫苗亚株的血清转阴率及血清保护率均明显降低;对AH3N2流感疫苗亚株的血清保护率显著降低;对于B型流感疫苗菌株，血清转阴率及血清保护率与正常人群相较无明显差异。流感病毒疫苗对SLEDAI评分均无影响。

结论

        流感病毒疫苗在SLE患者中的免疫原性取决于病毒株亚型，患者对A型流感病毒的免疫原性降低，但对B株的免疫原性被保留下来。23价肺炎球菌疫苗的免疫原性也被保留下来。这些疫苗对SLEDAI评分均无影响。

翻译者：高洁，西京医院临床免疫科

原文

        Rheumatology 2016;55:16641672 doi:10.1093/rheumatology/kew211 Advance Access publication 9 May 2016

Immunogenicity and impact on disease activity of influenza and pneumococcal vaccines in systemic lupus erythematosus: a systematic literature review and meta-analysis

        Objectives. The aim was to assess the immunogenicity and the impact on disease activity of pneumococcal and influenza vaccines in SLE patients.

        Methods. We conducted a systematic literature review and meta-analysis of studies comparing the humoral response of either pneumococcal (serotype 23F) or influenza (AH1N1, AH3N2 and B strains) vaccines between SLE patients and healthy controls, assessed by a seroconversion or a seroprotection rate 3-6 weeks after vaccination. The impact on disease activity was assessed by the comparison of the SLEDAI score before and 38 weeks after vaccination. Odds ratios (ORs), risk ratios and their 95% CIs were pooled using the generic inverse variance method.

        Results. Twenty studies were included, three for pneumococcal vaccine and 17 for influenza vaccine, gathering 1665 SLE patients and 826 healthy controls. For pneumococcal vaccination, no significant difference was observed, either for seroconversion rate between SLE patients and controls or for the SLEDAI score. For influenza vaccination, the response against AH1N1 was significantly reduced in SLE patients, with a lower rate of seroconversion (OR = 0.38; 95% CI: 0.27, 0.54; P<0.00001, I2 = 39%) and seroprotection (OR = 0.36; 95% CI: 0.28, 0.47; P<0.00001, I2 = 25%). For AH3N2, only seroprotection rate was significantly lower in SLE patients (OR = 0.26; 95% CI: 0.14, 0.50; P<0.0001, I2 = 21%). For B strain, neither seroconversion nor seroprotection rates were significantly different. Influenza vaccine did not modify the SLEDAI score.

        Conclusion. The immunogenicity of influenza vaccine in SLE patients depends on the viral strains. A reduced immunogenicity against influenza A is noted, while the immunogenicity against the B strain is preserved. The pneumococcal vaccine against 23F serotype has a preserved immunogenicity. These vaccines have no impact on the SLEDAI score.