Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France; Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2, CHRU de Lille, Equipe IBD and Environmental Factors: Epidemiology and Functional Analyses, Lille University, Lille, France; Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France; Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France.
Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France; Epidemiological Department, Lille University Hospital, Lille, France.
Clin Gastroenterol Hepatol. 2015 Aug;13(8):1405-15.e1; quiz e130. doi: 10.1016/j.cgh.2015.04.179. Epub 2015 May 5.
BACKGROUND & AIMS: Environmental factors may play a key role in the pathogenesis of inflammatory bowel disease (IBD). Whether vaccination is associated causally with IBD is controversial. We performed a meta-analysis of case-control and cohort studies on the association between vaccination and the risk for IBD.
Studies and abstracts investigating the relationship between vaccination and subsequent risk for developing IBD were reviewed. Childhood or adult immunizations with any vaccine type, at any dose, and with any vaccine schedule were used as inclusion criteria.
Eleven studies were included in the systematic review and meta-analysis: 8 case-control studies and 3 cohort studies. Studied vaccines were bacille Calmette-Guérin), vaccines against diphtheria, tetanus, smallpox, poliomyelitis, pertussis, H1N1, measles, rubella, mumps, and the combined measles, mumps, and rubella vaccine. Only a few details about vaccine type or route of administration were found in studies. Overall, there was no association between childhood immunization and risk for developing IBD: bacille Calmette-Guérin, relative risk (RR) of 1.04 (95% confidence interval [CI], 0.78-1.38), diphtheria, RR of 1.24 (95% CI, 0.80-1.94), tetanus, RR of 1.27 (95% CI, 0.77-2.08), smallpox, RR of 1.08 (95% CI, 0.70-1.67), poliomyelitis, RR of 1.79 (95% CI, 0.88-3.66), an measles containing vaccines, RR of 1.33 (95% CI, 0.31-5.80) in cohort studies, and RR of 0.85 (95% CI, 0.60-1.20) in case-control studies. Subgroup analysis for Crohn's disease (CD) and ulcerative colitis (UC) found an association between the poliomyelitis vaccine and risk for developing CD (RR, 2.28; 95% CI, 1.12-4.63) or UC (RR, 3.48; 95% CI, 1.2-9.71). The RR of developing IBD after H1N1 vaccination was 1.13 (95% CI, 0.97-1.32).
Results of this meta-analysis show no evidence supporting an association between childhood immunization or H1N1 vaccination in adults and risk of developing IBD. The association between the poliomyelitis vaccine and the risk for CD or UC should be analyzed with caution because of study heterogeneity.
环境因素可能在炎症性肠病（IBD）的发病机制中起关键作用。疫苗接种是否与 IBD 有因果关系仍存在争议。我们对疫苗接种与 IBD 风险之间的关系进行了病例对照和队列研究的荟萃分析。
综述了研究疫苗接种与随后发生 IBD 风险之间关系的研究和摘要。使用的纳入标准为儿童或成人接受任何疫苗类型、任何剂量和任何疫苗接种计划的免疫接种。
系统评价和荟萃分析纳入了 11 项研究：8 项病例对照研究和 3 项队列研究。研究疫苗包括卡介苗、白喉、破伤风、天花、脊髓灰质炎、百日咳、H1N1、麻疹、风疹、腮腺炎和麻疹、腮腺炎、风疹联合疫苗。研究中仅发现了关于疫苗类型或给药途径的一些细节。总体而言，儿童免疫接种与发展为 IBD 的风险之间没有关联：卡介苗，相对风险（RR）为 1.04（95%置信区间[CI]，0.78-1.38），白喉，RR 为 1.24（95%CI，0.80-1.94），破伤风，RR 为 1.27（95%CI，0.77-2.08），天花，RR 为 1.08（95%CI，0.70-1.67），脊髓灰质炎，RR 为 1.79（95%CI，0.88-3.66），麻疹疫苗，RR 为 1.33（95%CI，0.31-5.80）队列研究，病例对照研究 RR 为 0.85（95%CI，0.60-1.20）。对克罗恩病（CD）和溃疡性结肠炎（UC）的亚组分析发现，脊髓灰质炎疫苗与 CD（RR，2.28；95%CI，1.12-4.63）或 UC（RR，3.48；95%CI，1.2-9.71）风险之间存在关联。接种 H1N1 疫苗后发生 IBD 的 RR 为 1.13（95%CI，0.97-1.32）。
本荟萃分析结果表明，儿童免疫接种或成人接种 H1N1 疫苗与 IBD 风险之间没有证据表明存在关联。由于研究异质性，应谨慎分析脊髓灰质炎疫苗与 CD 或 UC 风险之间的关联。
