摘要
目的:探究23价肺炎球菌多糖疫苗预防支气管扩张症(支扩)及慢性阻塞性肺疾病(COPD)患者下呼吸道感染(LRTIs)的有效性以及安全性。方法:ELISA法检测20例支气管扩张症及12例COPD患者,接种肺炎疫苗前后,血清抗肺炎链球菌荚膜多糖IgG抗体含量。随访患者接种疫苗后不良反应情况,以及免疫前后1年各患者病情急性加重情况变化。结果:受试者免疫后抗体总体水平较前升高3.98倍,阳性率为78.13%(25/32例)。亚组分析结果显示,19F血清型免疫前抗体水平女性组较男性组低、免疫后浓度高于男性组,支扩组免疫后抗体浓度显著高于COPD组,23F血清型免疫后支气管扩张组抗体浓度低于COPD组,老年组免疫后抗体水平高于<65岁组,其余各血清型组间对比无明显统计学差异。临床结果显示免疫后下1年住院次数≥2次的人数、抗生素治疗次数、静脉使用糖皮质激素的次数均较免疫上1年明显下降,平均住院天数较上1年无明显统计学差异。结论:对支气管扩张及COPD患者,接种23价肺炎球菌多糖疫苗能有效预防下呼吸道感染,减少抗生素使用、减少住院次数,同时该疫苗具有安全性。
Objective：To evaluate the efficacy and safety of 23-valent pneumococcal polysaccharide vaccine（PPSV23）in prevention of lower respiratory tract infections（LRTIs）in patients with bronchiectasis and patients with COPD.Methods：ELISA was used to measure the serotype specific IgG antibody levels of 20 patients with bronchiectasis and 12 patients with COPD at baseline and30 days after vaccination.Patients were followed up to keep track of the side effects after vaccination PPSV23.During a 1-year follow-up period,we observed on the incidence and degree of LRTIs,usage rate of antibiotics,hospitalization rate and usage rate of systemic steroids.Results：Mean concentration of the serotype specific IgG antibody was 3.98 folds more after vaccination and the positive response was 78.13%（25/32）.There was some variation by serotype.Responses before vaccination were lower in female subjects（19F）and COPD subjects（19F）,while responses after vaccination were higher in the elderly（23F）,female subjects（19F）and COPD sub-jects（23F）.PPSV23 proved to be a protective factor in LRTIs,usage of antibiotics,hospitalization and usage of systemic steroids in this study.After a 1-year follow-up,LRTIs,usage of antibiotics,hospitalization and usage of systemic steroids all reduced sharply.But the vaccine did not reduce the length of hospital stay.Conclusion：PPSV23is safe for bronchiectasis and COPD patients,which is an effective prevention against lower respiratory tract infection,and can reduce the incidence of LRTIs,the amount of antibiotics usage and hospitalization.
作者
荣恒漠
杨炯
RONG Hengmo YANG Jiong(Dept. ofRespiratory, Zhongnan Hospital of Wuhan University, Wuhan 430071,China)
出处
《武汉大学学报（医学版）》
CAS
2017年第1期90-95,共6页
Medical Journal of Wuhan University
