登革热疫苗有效性及安全性的贝叶斯网状荟萃分析  

Bayesian network meta-analysis of the efficacy and safety of dengue vaccines

作　　者：姜雨淇 赵金华 龙江[4] 林英姿[3] 殷大鹏 罗会明 靳妍 金玉明 邓萍[1] 覃胜林 JIANG Yu-qi;ZHAO Jin-hua;LONG Jiang;LIN Ying-zi;YIN Da-peng;LUO Hui-ming;JIN Yan;JIN Yu-ming;DENG Ping;QIN Sheng-lin(Qinghai University Medical College,Xining,Qinghai 810000,China;不详)

机构地区：[1]青海大学医学院,青海西宁810000 [2]青海省疾病预防控制中心,青海西宁810007 [3]海南省疾病预防控制中心,海南海口571129 [4]重庆市疾病预防控制中心,重庆400700

出　　处：《现代预防医学》2024年第21期3841-3847,3859,共8页Modern Preventive Medicine

基　　金：国家自然科学基金委员会项目(12371503)。

摘　　要：目的运用贝叶斯网状荟萃(meta)分析评价五种登革热减毒活疫苗与一种登革热灭活疫苗的有效性和安全性,为登革热疫情防控和疫苗研发提供科学依据。方法基于PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库等中英文数据库,根据纳入标准与排除标准进行系统检索,筛选六种登革热疫苗的有效性与安全性的随机对照实验(randomized controlled trials,RCTs)。使用Rev Man5.4软件进行文献质量评价,R 4.3.1软件对符合纳入和排除标准的RCTs相关结局指标进行贝叶斯网状meta分析。结果共纳入20篇文献,120909例试验对象。贝叶斯网状meta分析结果显示:三种减毒活疫苗有效性能的作用显著,有效性能高低依次为:Butantan-DV>TAK-003>CYD-TDV,其中结合血清4型非结构基因和血清2型结构基因的登革热疫苗(Butantan-DV)预防效果最佳,注射后患有登革热的风险概率小于注射其他疫苗(OR=0.22,95%CI:0.09~0.45);安全性上纳入六种疫苗,累积发生不良事件的风险概率依次为:V180>CYD-TDV>TV003>TV005>Butantan-DV>TAK-003。其中灭活疫苗(V180)发生不良事件风险较大(OR=2.28,95%CI:1.02~5.15)。结论基于本文纳入研究数量和质量基础,三种减毒活疫苗中有效性Butantan-DV最优、CYD-TDV最弱,安全性TAK-003相对较好。V180、TV003、TV005疫苗有效性实验的文献十分少见,可作为未来研究方向之一。Objective To evaluate the efficacy and safety of five live attenuated dengue vaccines and one inactivated dengue vaccine using Bayesian network meta-analysis,providing a scientific basis for dengue epidemic prevention and control as well as vaccine development.Methods A systematic search was conducted in various Chinese and English databases,including PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),and Wan fang Database,based on predefined inclusion and exclusion criteria.Randomized controlled trials(RCTs)assessing the efficacy and safety of six dengue vaccines were selected.The quality of the literature was evaluated using RevMan 5.4 software,and Bayesian network meta-analysis of relevant outcome indicators from the included RCTs was performed using R 4.3.1 software.Results A total of 20 studies involving 120909 participants were included.The results of the Bayesian network meta-analysis indicated that the efficacy of three live attenuated vaccines was notable and the ranking from highest to lowest efficacy was as follows:Butantan-DV>TAK-003>CYD-TDV.Among these,the dengue vaccine combining serotype 4 non-structural genes and serotype 2 structural genes(Butantan-DV)showed the best preventive effect,with a risk probability of dengue infection post-vaccination lower than that of other vaccines(OR=0.22,95%CI:0.09-0.45).In terms of safety,the six vaccines showed varying risks of adverse events and ranked as follows:V180>CYD-TDV>TV003>TV005>Butantan-DV>TAK-003.Notably,the inactivated vaccine(V180)presented a higher risk of adverse events(OR=2.28,95%CI:1.02-5.15).Conclusion Based on the quantity and quality of the included studies,Butantan-DV exhibited the best efficacy among the three live attenuated vaccines,while CYD-TDV demonstrated the weakest efficacy.TAK-003 showed relatively better safety.The literature on the efficacy of the V180,TV003,and TV005 vaccines is quite limited,suggesting potential directions for future research.

关 键 词：登革热疫苗 有效性 安全性 贝叶斯网状Meta分析 减毒活疫苗 

分 类 号：R186.3[医药卫生—流行病学]