成人自身免疫性炎症性风湿病患者的疫苗接种：为欧洲抗风湿病联盟成人自身免疫性炎症性风湿病患者疫苗接种的循证推荐而进行的系统文献回顾。

Vaccination in adult patients with auto-immune inflammatory rheumatic diseases: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases.

机构信息

Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.

出版信息

Autoimmun Rev. 2011 Apr;10(6):341-52. doi: 10.1016/j.autrev.2010.12.003. Epub 2010 Dec 20.

DOI:10.1016/j.autrev.2010.12.003

PMID:21182987

Abstract

OBJECTIVES

To present the systematic literature review (SLR), which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for vaccination in adult patients with auto-immune inflammatory rheumatic diseases (AIIRD).

METHODS

AIIRD, vaccines and immunomodulating drugs, as well as eight key questions were defined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A SLR was performed using MedLine through October 2009 and including data from meta-analyses, systematic reviews, randomized trials, and observational studies, excluding case series with ≤ 5 participants. Articles in English and regarding patients ≥ 16 years of age, were eligible.

RESULTS

Several vaccine-preventable infections (VPI) occur more often in AIIRD-patients and most vaccines are efficacious in AIIRD-patients, even when treated with immunomodulating agents, except rituximab. There does not appear to be an increase in vaccination-related harms in vaccinated patients with AIIRD in comparison with unvaccinated patients with AIIRD. However, these studies are underpowered and therefore not conclusive.

CONCLUSION

Based on the current evidence from the literature, recommendations for vaccination in patients with AIIRD were made. However, more research is needed in particular regarding incidence of VPI, harms of vaccination and the influence of (new and established) immunomodulating agents on vaccination efficacy.

摘要

目的

呈现系统文献综述（SLR），该综述为欧洲抗风湿病联盟（EULAR）制定的成人自身免疫性炎症性风湿病（AIIRD）患者疫苗接种的循证建议提供了依据。

方法

EULAR 委托多学科专家委员会定义了 AIIRD、疫苗和免疫调节剂、以及 8 个关键问题。通过 MedLine 进行了 SLR，检索时间截至 2009 年 10 月，包括荟萃分析、系统评价、随机试验和观察性研究的数据，排除了仅有≤5 名参与者的病例系列研究。合格的文章应为英文，且针对年龄≥16 岁的患者。

结果

AIIRD 患者更常发生一些可通过疫苗预防的感染（VPI），并且大多数疫苗在 AIIRD 患者中有效，即使在使用免疫调节剂治疗时也是如此，除了利妥昔单抗。与未接种疫苗的 AIIRD 患者相比，接种疫苗的 AIIRD 患者中似乎没有增加与疫苗接种相关的危害。然而，这些研究的效力不足，因此无法得出结论。