Holvast Bert, Huckriede Anke, Kallenberg Cees G M, Bijl Marc
Department of Clinical Immunology, University Medical Center Groningen, University of Groningen, The Netherlands.
Autoimmun Rev. 2007 Apr;6(5):300-5. doi: 10.1016/j.autrev.2006.09.012. Epub 2006 Oct 16.
Patients with systemic lupus erythematosus (SLE) show decreased immune responsiveness and are vulnerable for infectious diseases, due to the underlying disease and the frequent use of immunosuppressive drugs. Influenza has a high incidence in the population and is associated with increased morbidity and mortality in immunocompromised patients. Therefore, routine influenza vaccination of SLE patients seems indicated. However, there have been concerns about the safety of influenza vaccination in SLE as vaccination was thought to activate the autoimmune response. Safety of influenza vaccination has been studied, and, as far as SLE patients with quiescent disease are concerned, it is now generally accepted that influenza vaccination is safe. Another point of concern is vaccine efficacy. In immunocompromised patients, the immunogenicity of vaccines may be reduced. In the immune response to influenza (vaccination) both humoral and cell-mediated responses are involved. In SLE, research on the immune response to influenza vaccination has focused on humoral immune responses, demonstrating a blunted humoral response. Future research should focus on cell-mediated immune responses as well, as these are important for clearing of influenza infection and are expected to be impaired in SLE. Because of the decreased immunogenicity of the current influenza vaccine in SLE, new influenza vaccination strategies should be explored to improve vaccination efficacy.
系统性红斑狼疮（SLE）患者由于基础疾病以及频繁使用免疫抑制药物，免疫反应性降低，易患感染性疾病。流感在人群中发病率高，且与免疫功能低下患者的发病率和死亡率增加相关。因此，SLE患者常规接种流感疫苗似乎是必要的。然而，由于认为接种疫苗会激活自身免疫反应，人们一直担心SLE患者接种流感疫苗的安全性。流感疫苗接种的安全性已得到研究，就病情静止的SLE患者而言，现在普遍认为流感疫苗接种是安全的。另一个关注点是疫苗效力。在免疫功能低下的患者中，疫苗的免疫原性可能会降低。在对流感（疫苗接种）的免疫反应中，体液免疫反应和细胞介导的免疫反应均有涉及。在SLE中，对流感疫苗接种免疫反应的研究主要集中在体液免疫反应上，结果显示体液免疫反应减弱。未来的研究也应关注细胞介导的免疫反应，因为这些反应对于清除流感感染很重要，并且预计在SLE中会受损。由于目前的流感疫苗在SLE中的免疫原性降低，应探索新的流感疫苗接种策略以提高疫苗接种效力。
