Kuo Chia-Sheng, Lu Chia-Wen, Chang Yu-Kang, Yang Kuen-Cheh, Hung Shou-Hung, Yang Ming-Ching, Chang Hao-Hsiang, Huang Chi-Ting, Hsu Chih-Cheng, Huang Kuo-Chin
aDepartment of Community and Family Medicine, National Taiwan University Hospital YunLin Branch bCollege of Public Health, National Taiwan University cDepartment of Family Medicine, National Taiwan University Hospital dInstitute of Population Health Sciences, National Health Research Institutes, Zhunan eDepartment of Community and Family Medicine, National Taiwan University Hospital Bei-Hu Branch fDepartment of Health Services Administration, China Medical University, Taichung gMin-Sheng General Hospital, Taoyuan, Taiwan.
Medicine (Baltimore). 2016 Jun;95(26):e4064. doi: 10.1097/MD.0000000000004064.
Diabetes mellitus is associated with increased risk of pneumonia, and 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for prevention of pneumonia. However, the effectiveness of PPV23 remains unclear in the older diabetic patients who usually have compromised immune function.We used data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) from 2000 to 2009 to conduct a population-based retrospective cohort study, comparing the incidence of pneumococcal diseases among PPV23-vaccinated and propensity-score matched PPV23-unvaccinated groups in diabetic elderly. The primary outcome was invasive pneumococcal diseases (IPDs), and the secondary outcomes were medical utilization.PPV23-vaccinated group had reduced risks of IPD (adjusted OR: 0.86, 95% CI: 0.78-0.94), respiratory failure (0.84, 0.77-0.93), and shorter length of hospitalization (-1.27 ± 0.19 days, P value: 0.0012). In flu-vaccinated group, subjects who received PPV23 had reduced risks of IPD, hospitalization, and respiratory failure; had shorter lengths of hospitalization; and less medical costs, than those without receiving PPV23. In not flu-vaccinated group, PPV23 vaccination was associated with reduced risks of IPD and respiratory failure. Receiving both vaccines could bring better protection in IPD, hospitalization, visits of emergency department, and respiratory failure.PPV23 vaccination was effective in prevention of pneumococcal diseases and reduction of medical utilization in diabetic elderly aged 75 and more. Receiving both vaccines resulted in better outcomes than PPV vaccination alone.
糖尿病与肺炎风险增加相关，23价肺炎球菌多糖疫苗（PPV23）被推荐用于预防肺炎。然而，PPV23在免疫功能通常受损的老年糖尿病患者中的有效性仍不明确。我们使用从2000年至2009年台湾国民健康保险研究数据库（NHIRD）中提取的数据进行了一项基于人群的回顾性队列研究，比较了糖尿病老年人中接种PPV23组和倾向评分匹配的未接种PPV23组的肺炎球菌疾病发病率。主要结局是侵袭性肺炎球菌疾病（IPD），次要结局是医疗利用情况。接种PPV23组的IPD风险降低（调整后的OR：0.86，95%CI：0.78 - 0.94）、呼吸衰竭风险降低（0.84，0.77 - 0.93），住院时间缩短（-1.27 ± 0.19天，P值：0.0012）。在接种流感疫苗的组中，与未接种PPV23的受试者相比，接种PPV23的受试者IPD、住院和呼吸衰竭风险降低；住院时间更短；医疗费用更低。在未接种流感疫苗的组中，PPV23疫苗接种与IPD和呼吸衰竭风险降低相关。同时接种两种疫苗在预防IPD、住院、急诊就诊和呼吸衰竭方面能带来更好的保护。PPV23疫苗接种在预防75岁及以上糖尿病老年人的肺炎球菌疾病和降低医疗利用方面是有效的。同时接种两种疫苗比单独接种PPV疫苗能带来更好的结局。
