老年人接种23价肺炎球菌多糖疫苗保护效果的Meta分析

目的 评价60岁以上老年人接种23价肺炎球菌多糖疫苗(PPV23)对侵袭性肺炎球菌疾病(IPD)和肺炎球菌肺炎(PP)的保护效果.方法 电子检索National Center for Biotechnology Information、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库和万方全文数据库等数据库,将60岁以上老年人接种PPV23流行病学保护效果的随机对照试验、队列研究、病例对照研究纳入研究.合并各项研究中关于接种组和对照组间发生IPD、PP的相对危险度(RR)或比值比(OR).在合并RR或OR有统计学意义的情况下,计算疫苗效力.使用RevMan 5.3软件进行统计分析.结果 共纳入4篇随机对照研究、5篇队列研究和8篇病例对照研究.随机对照研究合并后显示接种PPV23后对IPD和PP的疫苗效力分别是73％(95％CI:10％～92％),64％ (95％ CI:35％ ～80％);队列研究合并后显示对IPD和PP的疫苗效力分别为45％ (95％CI:15％～65％),48％ (95％CI:25％～63％);病例对照研究合并显示对IPD和PP的疫苗效力分别是59％ (95％ CI:35％～74％),45％(95％CI:27％～59％).结论 60岁以上老年人接种PPV23后对IPD和PP均有良好的保护效果,而且由于PPV23覆盖肺炎球菌血清型别较广,可以有效减少IPD、PP发病,值得在60岁以上老年人中推广使用.

Meta-analysis on protective efficacy of 23-valent pneumococcal polysaccharide vaccine in aged people

Objective To evaluate protective efficacy of 23-valent pneumococcal polysaccharide vaccine (PPV23) against invasive pneumococcal disease (IPD) and pneumococcal pneumonia(PP) in the population aged above 60 years.Methods By searching databases such as National Center for Biotechnology Information,Cochrane Library,China Biology Medicine disc,China National Knowledge Infrastructure and Wanfang Database,we included randomized controlled trial (RCT),cohort study,case-control study on efficacy of PPV23 against IPD or PP in the population aged ≥60 years in the research.The relative risk (RR) or odds ratio(OR)for IPD and PP between vaccination group and control group from each study were pooled.Vaccine efficacy (VE) was calculatedif the pooled estimates of RR or OR were statistical significant.RevMan 5.3 software was adopted for all analyses.Results We identified 4 RCT studies,5 cohort studies and 8 case-control studies.Pooled VEs against IPD and PP in RCT were 73％ (95％CI:10％-92％) and 64％ (95％CI:35％-80％),respectively.Pooled VEs against IPD and PP in cohort studies were 45％(95％CI:15％-65％) and 48％(95％CI:25％-63％),respectively.Pooled VEs against IPD and PP in case-control studies were 59％ (95％CI:35％-74％) and 45％ (95％CI:27％-59％),respectively.Conclusions Our meta-analysis reveals significant VE of PPV23 against both IPD and PP in the population aged over 60 years.Due to its broad serotype coverage and the effectiveness of reducing the incidences of IPD and PP,PPV23 is recommended in the elderly aged above 60 years.