摘要目的 探索流行性感冒病毒裂解疫苗(流感疫苗)和23价肺炎球菌多糖疫苗(肺炎疫苗)接种对老年COPD患者症状改善效果.方法 2013年11月至2014年10月,分别在重庆市和宁波市的各3个国家级慢性病综合防控示范区各选择4个社区组,整群抽样分为流感疫苗接种组、肺炎疫苗接种组、流感疫苗与肺炎疫苗联合接种组和对照组,以COPD患者自我评估测试(COPD assessment test,CAT)结果为主要评估指标,观察并比较社区内60 ～ 75岁COPD患者疫苗接种1年后症状改善程度.采用SAS 9.4软件分析,比较COPD患者疫苗接种前后的CAT评分及其症状改善的情况.结果 对4个社区组COPD患者使用倾向评分方法进行匹配后,共纳入研究对象1 244人.基线CAT评分M=21 (IQR:17～ 26)分.接种疫苗1年后,CAT评分M=18 (IQR:14～ 24)分,3个疫苗接种组的CAT评分均有明显降低,差异有统计学意义(流感疫苗接种组,配对t=-6.531,P=0.403;肺炎疫苗接种组,Wilcoxon配对检验H=-9 623,P＜0.001;流感及肺炎疫苗联合接种组,配对t=-10.803,P＜0.001),而对照组患者CAT评分无明显改善,差异无统计学意义(Wilcoxon配对检验H=1 167,P=0.403).CAT分级为“严重影响”及“非常严重影响”者比例在3个疫苗接种组明显降低,对照组变化不明显.析因分析发现流感疫苗对COPD患者整体症状、以及咳嗽、胸闷、气喘、活动、外出、精力6项指标均有改善作用;肺炎疫苗对整体症状及全部8项单独指标均有改善作用.结论 对COPD患者给予流感疫苗和肺炎疫苗接种可有效改善其疾病症状.

abstractsObjective To explore the effect of influenza and 23 valent pneumococcal polysaccharide pneumococcal vaccinations on symptom-improvement among elderly with chronic obstructive pulmonary diseases (COPD).Methods Data was gathered from 4 communities in 3 National Demonstration Areas set for comprehensive prevention and control of chronic non-communicable diseases in Chongqing city and Ningbo city respectively,from November 2013 to October 2014.The communities were selected by cluster sampling and divided into 4 groups:(1) injected influenza vaccines;(2) injected with pneumococcal vaccines;(3) received both of the two vaccines;(4) the control group that without any intervention measures.All the subjects aged from 60 to 75 were selected to fill in demographic information questionnaire and receive (COPD assessment test,CAT) scores twice,before intervention and 1 year after the vaccination.SAS 9.4 software was used to analyze the change of symptoms and CAT scores before and after the intervention program and comparing the improvement on symptoms among the elderly people under study.Results A total of 1 244 subjects with nearly same baseline conditions after the propensity score matching,were involved in this study.CAT scores appeared as Median=21 (IQR:17-26) at baseline.The CAT scores appeared as Median=18 (IQR:14-24),decreasing in all the 3 vaccinated groups,one year after the intervention program (influenza vaccines,matching t test,t=-6.531,P=0.403;pneumococcal vaccines,Wilcoxon test,H=-9 623,P＜0.001;combined vaccine vaccines,matching t test,t=-10.803,P＜0.001).However,in the control group,no obvious change was observed (Wilcoxon H=1 167,P=0.403).Proportions of impacts at high or very high levels all decreased in the 3 intervention groups,while little change was observed in the control group.Outcomes from the Factorial analysis suggested that influenza vaccination could improve the general conditions and symptoms including cough,chest tightness,dyspnea,physical activities,and stamina.Pneumococcal vaccination appeared more effective on all of symptoms and indicators.Conclusion Pneumococcal and influenza vaccination seemed helpful for elderly people suffering COPD to improve the general health condition.