Department of Rheumatology and Immunology, Jinshan Hospital of Fudan University, Shanghai 201508, China; Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai 201508, China.
Department of Epidemiology and Biostatistics, School of Public Health, Hebei Medical University, Shijiazhuang 050017, China; Department of Library, Hebei Medical University, Shijiazhuang 050017, China.
Autoimmun Rev. 2017 Jul;16(7):756-765. doi: 10.1016/j.autrev.2017.05.012. Epub 2017 May 5.
In the past several years, more and more studies proposed some concerns on the possibly increased risk of autoimmune diseases in individuals receiving vaccinations, but published studies on the associations of vaccinations with risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) reported conflicting findings. A systematic review and meta-analysis was carried out to comprehensively evaluate the relationship between vaccinations and risk of SLE and RA.
Pubmed, Web of Science and Embase were searched for observational studies assessing the associations of vaccinations with risks of RA and SLE. Two authors independently extracted data from those eligible studies. The quality of eligible studies was assessed by using the Newcastle-Ottawa Scale (NOS). The pooled relative risk (RR) with 95% confidence intervals (CIs) was used to measure the risk of RA and SLE associated with vaccinations, and was calculated through random-effect meta-analysis.
Sixteen observational studies were finally considered eligible, including 12 studies on the association between vaccinations and SLE risk and 13 studies on the association between vaccinations and RA risk. The pooled findings suggested that vaccinations significantly increased risk of SLE (RR=1.50; 95%CI 1.05-2.12, P=0.02). In addition, there was an obvious association between vaccinations and increased risk of RA (RR=1.32; 95%CI 1.09-1.60, P=0.004). Meta-analysis of studies reporting outcomes of short vaccinated time also suggested that vaccinations could significantly increase risk of SLE (RR=1.93; 95%CI 1.07-3.48, P=0.028) and RA (RR=1.48; 95%CI 1.08-2.03, P=0.015). Sensitivity analyses in studies with low risk of bias also found obvious associations of vaccinations with increased risk of RA and SLE.
This study suggests that vaccinations are related to increased risks of SLE and RA. More and larger observational studies are needed to further verify the findings above and to assess the associations of vaccinations with other rheumatic diseases.
在过去的几年中，越来越多的研究对接受疫苗接种的个体患自身免疫性疾病的风险可能增加提出了一些担忧，但已发表的关于疫苗接种与系统性红斑狼疮（SLE）和类风湿关节炎（RA）风险关联的研究报告结果存在矛盾。因此，进行了一项系统评价和荟萃分析，以全面评估疫苗接种与 SLE 和 RA 风险之间的关系。
检索 Pubmed、Web of Science 和 Embase 以评估疫苗接种与 RA 和 SLE 风险关联的观察性研究。两位作者独立提取符合条件的研究中的数据。使用纽卡斯尔-渥太华量表（NOS）评估合格研究的质量。使用随机效应荟萃分析计算合并相对风险（RR）及其 95%置信区间（CI）来衡量疫苗接种与 SLE 和 RA 相关的风险。
最终有 16 项观察性研究被认为符合条件，包括 12 项关于疫苗接种与 SLE 风险关联的研究和 13 项关于疫苗接种与 RA 风险关联的研究。汇总结果表明，疫苗接种显著增加 SLE 的风险（RR=1.50；95%CI 1.05-2.12，P=0.02）。此外，疫苗接种与 RA 风险增加之间存在明显关联（RR=1.32；95%CI 1.09-1.60，P=0.004）。对报告短期接种时间结果的研究进行荟萃分析也表明，疫苗接种可显著增加 SLE（RR=1.93；95%CI 1.07-3.48，P=0.028）和 RA（RR=1.48；95%CI 1.08-2.03，P=0.015）的风险。对低偏倚风险研究进行敏感性分析也发现疫苗接种与 RA 和 SLE 风险增加之间存在明显关联。
本研究表明，疫苗接种与 SLE 和 RA 的风险增加有关。需要进行更多和更大规模的观察性研究来进一步验证上述发现，并评估疫苗接种与其他风湿性疾病的关联。
