Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
J Neurol Sci. 2018 Mar 15;386:12-18. doi: 10.1016/j.jns.2018.01.007. Epub 2018 Jan 8.
There is mounting evidence supporting infection as an independent risk factor for ischemic stroke (IS), while preliminary data indicate that vaccination may prevent IS. We performed a systematic review and meta-analysis of available randomized clinical trials (RCTs) or prospective observational cohorts reporting associations of influenza vaccination (IV) and/or pneumococcal vaccination (PV) with IS. We identified a total of 12 studies (543,311 patients; 47.4% vaccinated). Vaccination was not related to the risk of IS (RR=1.06, 95%CI: 0.74-1.51, p=0.77), with no significant differences (p=0.26) among RCTs (RR=0.66, 95%CI: 0.30-1.47) and observational studies (RR=1.11, 95%CI: 0.76-1.61). Evidence of considerable heterogeneity was identified within observational studies (I=98%), but not within RCTs (I=0%). In subgroup analyses according to vaccination type, IV was associated with a significantly lower risk of IS (RR=0.87, 95%CI: 0.79-0.96, p=0.004) with moderate evidence of heterogeneity (I=53%). No association was seen for PV (RR=1.38, 95%CI: 0.60-3.16, p=0.45), where considerable heterogeneity was identified (I=97%). In the additional adjusted analyses of observational studies, vaccination tended to be associated with lower risk of IS (HRadjusted=0.87; 95%CI: 0.75-1.01; p=0.07). The findings of this meta-analysis indicate that IV may be associated with a lower risk of IS. This association was not reproduced for PV or the combination of two vaccines. Substantial heterogeneity was detected across observational studies for all outcome events, while moderate to low heterogeneity was identified across included RCTs. These preliminary findings require independent validation in large RCTs.
越来越多的证据表明感染是缺血性卒中（IS）的独立危险因素，而初步数据表明疫苗接种可能预防 IS。我们对报道流感疫苗（IV）和/或肺炎球菌疫苗（PV）接种与 IS 之间关联的现有随机临床试验（RCT）或前瞻性观察队列进行了系统评价和荟萃分析。我们共确定了 12 项研究（543311 例患者；47.4%接种疫苗）。接种疫苗与 IS 风险无关（RR=1.06，95%CI：0.74-1.51，p=0.77），RCT 之间无显著差异（p=0.26）（RR=0.66，95%CI：0.30-1.47）和观察性研究（RR=1.11，95%CI：0.76-1.61）。观察性研究中存在显著的异质性（I=98%），但 RCT 中不存在（I=0%）。根据疫苗类型进行亚组分析，IV 与 IS 风险显著降低相关（RR=0.87，95%CI：0.79-0.96，p=0.004），异质性中度（I=53%）。PV 无相关性（RR=1.38，95%CI：0.60-3.16，p=0.45），其中存在显著的异质性（I=97%）。在对观察性研究的进一步调整分析中，接种疫苗往往与 IS 风险降低相关（HRadjusted=0.87；95%CI：0.75-1.01；p=0.07）。荟萃分析的结果表明，IV 可能与 IS 风险降低相关。PV 或两种疫苗联合接种未再现这种相关性。所有结局事件的观察性研究均存在显著异质性，而纳入的 RCT 存在中至低度异质性。这些初步发现需要在大型 RCT 中进行独立验证。
