免疫抑制依赖性小儿炎症性肠病的疫苗接种。
Vaccinations in immunosuppressive-dependent pediatric inflammatory bowel disease.
机构信息
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
出版信息
World J Gastroenterol. 2017 Nov 14;23(42):7644-7652. doi: 10.3748/wjg.v23.i42.7644.
AIM
To determine the vaccination rates in pediatric immunosuppression-dependent inflammatory bowel disease (IBD) and review the safety and efficacy of vaccinations in this population.
METHODS
The electronic medical records from October 2009 to December 2015 of patients diagnosed with IBD at 10 years of age or younger and prescribed anti-tumor necrosis factor alpha (anti-TNF-α) therapy were reviewed for clinical history, medication history, vaccination history, and hepatitis B and varicella titers. Literature discussing vaccination response in IBD patients were identified through search of the MEDLINE database and reviewed using the key words "inflammatory bowel disease", "immunization", "vaccination", "pneumococcal", "varicella", and "hepatitis B". Non-human and non-English language studies were excluded. Search results were reviewed by authors to select articles that addressed safety and efficacy of immunizations in inflammatory bowel disease.
RESULTS
A total of 51 patients diagnosed with IBD prior to the age of 10 and receiving anti-TNF-α therapy were identified. Thirty-three percent of patients (17/51) had incomplete or no documentation of vaccinations. Sixteen case reports, cohort studies, cross-sectional studies, and randomized trials were determined through review of the literature to describe the safety and efficacy of hepatitis B, pneumococcal, and varicella immunizations in adult and pediatric patients with IBD. These studies showed that patients safely tolerated the vaccines without significant adverse effects. Importantly, IBD patients receiving immunosuppressive medications, particularly anti-TNF-α treatment, have decreased vaccine response compared to controls. However, the majority of patients are still able to achieve protective levels of specific antibodies.
CONCLUSION
Immunizations have been shown to be well-tolerated and protective immunity can be achieved in patients with IBD requiring immunosuppressive therapy.
目的
确定小儿免疫抑制依赖性炎症性肠病（IBD）的疫苗接种率，并回顾该人群中疫苗接种的安全性和有效性。
方法
回顾 2009 年 10 月至 2015 年 12 月期间在 10 岁或 10 岁以下被诊断患有 IBD 并接受抗肿瘤坏死因子-α（anti-TNF-α）治疗的患者的电子病历，记录其临床病史、用药史、疫苗接种史以及乙型肝炎和水痘病毒滴度。通过 MEDLINE 数据库检索“炎症性肠病”、“免疫接种”、“疫苗接种”、“肺炎球菌”、“水痘”和“乙型肝炎”等关键词，查找 IBD 患者疫苗接种反应的文献，并进行综述。排除非人类和非英语语言的研究。作者对检索结果进行了回顾，选择了涉及 IBD 患者免疫接种安全性和有效性的文章。
结果
共确定了 51 名在 10 岁之前被诊断为 IBD 并接受 anti-TNF-α 治疗的患者。33%的患者（17/51）的疫苗接种记录不完整或缺失。通过文献回顾，确定了 16 份病例报告、队列研究、横断面研究和随机试验，以描述成人和儿童 IBD 患者接种乙型肝炎、肺炎球菌和水痘疫苗的安全性和有效性。这些研究表明，患者安全耐受疫苗，无明显不良反应。重要的是，与对照组相比，接受免疫抑制药物治疗的 IBD 患者，尤其是接受 anti-TNF-α 治疗的患者，疫苗反应降低。然而，大多数患者仍能达到特定抗体的保护水平。
结论
免疫接种已被证明是安全有效的，在需要免疫抑制治疗的 IBD 患者中可以获得保护性免疫。
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