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慢性阻塞性肺疾病初诊患者流感和肺炎疫苗接种状况及影响因素：真实世界横断面研究
刘聪
彭雅婷
李静
林铃
宋庆
成玮
曾玉琴
陈平
作者及单位信息
·
DOI： 10.3760/cma.j.cn112147-20211019-00727
Status of vaccination and related influencing factors in patients with chronic obstructive pulmonary disease: a real-world cross-sectional study
Liu Cong
Peng Yating
Li Jing
Lin Ling
Song Qing
Cheng Wei
Zeng Yuqin
Chen Ping
Authors Info & Affiliations
Liu Cong
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Peng Yating
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Li Jing
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Lin Ling
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Song Qing
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Cheng Wei
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Zeng Yuqin
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
Chen Ping
Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha 410011, China
·
DOI： 10.3760/cma.j.cn112147-20211019-00727
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摘要

目的调查慢性阻塞性肺疾病（简称慢阻肺）初诊患者流感、肺炎疫苗接种现状，分析影响疫苗接种的因素。

方法连续纳入2016年12月至2019年12月在中南大学湘雅二医院呼吸科门诊初次就诊的慢阻肺患者3 177例，其中男2 683例，女494例，年龄20~89（62.1±9.0）岁，询问患者就诊后1年内疫苗接种状况，分析患者的一般情况和调查资料，用logistic回归分析与疫苗未接种的相关因素。

结果慢阻肺患者总体流感疫苗、肺炎疫苗及流感联合肺炎疫苗接种率分别为2.3%（72/3 177）、1.1%（34/3 177）和1.1%（34/3 177）。城镇患者流感疫苗接种率3.3%（41/1 252），高于农村患者接种率1.6%（31/1 925， P=0.002）。已戒烟患者流感疫苗、肺炎疫苗、流感联合肺炎疫苗接种率分别为3.3%（33/993）、2.1%（21/993）和2.1%（21/993），均高于目前仍吸烟的患者［1.7%（25/1 467）、0.7%（11/1 467）、0.7%（11/1 467）， P=0.034、0.015、0.015］。CAT<10分的慢阻肺患者流感疫苗接种率4%（27/673），高于CAT≥10分患者的接种率1.8%（45/2 504， P=0.002）。农村居住（ aOR值为1.73，95% CI：1.02~2.93， P=0.044）、吸烟（ aOR值为2.10，95% CI：1.18~3.76， P=0.012）、CAT评分高（ aOR值为2.06，95% CI：1.24~3.43， P=0.005），慢阻肺患者未接种疫苗的可能性更大。慢阻肺患者未接种疫苗最主要的原因是不知晓应接种疫苗（81.2%）。

结论慢阻肺患者接种流感疫苗、肺炎疫苗及流感联合肺炎疫苗的比例均很低，且缺乏对疫苗的知晓。居住地、吸烟状态、症状与慢阻肺患者未接种疫苗相关，在对患者进行疫苗的健康宣教中需考虑到这些因素的影响。

音频摘要
中南大学湘雅二医院呼吸与危重症医学科刘聪等研究2016年12月至2019年12月在门诊初次就诊的慢性阻塞性肺疾病患者3 177例，询问患者就诊后1年内疫苗接种状况，分析影响疫苗接种的因素。研究发现慢阻肺患者接种流感疫苗、肺炎疫苗及流感联合肺炎疫苗的比例均很低，且缺乏对疫苗的知晓。居住地、吸烟状态、症状与慢阻肺患者未接种疫苗相关，在对患者进行疫苗的健康宣教中需考虑到这些因素的影响。
肺疾病，慢性阻塞性;接种率;健康宣教
ABSTRACT

ObjectiveTo investigate the influenza and pneumonia vaccination rates in patients with chronic obstructive pulmonary disease (COPD), and analyze the factors affecting vaccination.

MethodsTotally 4 016 COPD patients at the initial visit were included in the Respiratory Department of Xiangya Second Hospital of Central South University from December, 2016 to December, 2019. Each patient′s vaccination status after the visit for 1 year was reviewed, and finally 3 177 patients were included in the analysis. Relevant factors affecting vaccination were analyzed with logistic regression.

ResultsThe overall vaccination rates of COPD patients with influenza vaccine, pneumonia vaccine and influenza combined pneumonia vaccine were 2.3% (72/3 177), 1.1% (34/3 177) and 1.1% (34/3 177), respectively. The influenza vaccination rate of urban patients (3.3%, 41/1 252) was higher than that of rural patients (1.6%, 31/1 925, P=0.002). The rates of influenza vaccine, pneumonia vaccine and influenza combined pneumonia vaccine in ex-smokers with COPD were 3.3% (33/993), 2.1% (21/993), 2.1% (21/993), respectively and 1.7% (25/1 467), 0.7% (11/1 467), 0.7% (11/1 467), in current smokers with COPD, respectively ( P=0.034, P=0.015, P=0.015, respectively). The influenza vaccination rate was higher in patients with COPD assessment test (CAT) scored less than 10 (4%, 27/673) than patients with CAT scored more than 10 (1.8%, 45/2 504, P=0.002). In a multifactor analysis, patients who lived in country side, were current smokers, and had more symptoms were less likely to be vaccinated, with an aOR 1.73(95% CI 1.02-2.93), 2.10(95% CI 1.18-3.76), 2.06(95% CI 1.24-3.43), respectively. 81.2% of COPD patients did not receive the vaccine because they did not know the vaccine.

ConclusionsVaccination rates for influenza vaccine, pneumonia vaccine and both of them in COPD patients were low and the patients lacked knowledge of vaccine. The residence, smoking status and symptoms were related to the vaccination of COPD patients, and these should be taken into account in the vaccination health education.

Pulmonary disease, chronic obstructive;Influenza vaccine;Pneumonia vaccine
Chen Ping, Email: nc.defudabe.usc1370nehcgnip
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引用本文

刘聪,彭雅婷,李静,等. 慢性阻塞性肺疾病初诊患者流感和肺炎疫苗接种状况及影响因素：真实世界横断面研究[J]. 中华结核和呼吸杂志,2022,45(04)：355-361.

DOI:10.3760/cma.j.cn112147-20211019-00727

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慢性阻塞性肺疾病（简称慢阻肺）是一种长期暴露于危险因素后气道发生不可逆的可防治的常见慢性呼吸系统疾病。2007年我国40岁以上人群慢阻肺的患病率为8.2% ［ 1 ］ ，最新慢阻肺流行病学调查显示40岁及以上人群慢阻肺患病率为13.7%，并且随着年龄的增长患病率显著上升，年龄≥70岁的患病率为35.5% ［ 2 ］ 。随着我国人口老龄化，慢阻肺的经济负担可能越来越重。国家2019年发布的《健康中国行动（2019—2030年）》指出，慢性呼吸系统疾病被列为专项计划之一，并指出需要加强对慢阻肺患者健康管理 ［ 3 ］ 。慢阻肺全球倡议及我国慢阻肺指南均推荐慢阻肺患者每年接种流感疫苗，每5年接种肺炎疫苗，以减少急性加重的风险 ［ 4 , 5 ］ 。樊静等 ［ 6 ］ 回顾性调查发现2014至2015年我国≥40岁慢阻肺患者过去5年内肺炎疫苗接种率是0.8%（95% CI：0.3%~1.4%），过去1年内流感疫苗接种率是3.6% ［ 7 ］ 。但是，在现实世界中，慢阻肺患者被确诊后流感、肺炎疫苗的接种状况，尚不清楚。本研究是一项真实世界的横断面回顾性调查，通过初诊慢阻肺患者就诊后1年内流感、肺炎疫苗接种的现状，进一步分析影响慢阻肺患者疫苗接种的相关因素。
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备注信息
A
陈平，Email： nc.defudabe.usc1370nehcgnip
B

刘聪：酝酿和设计实验、实施研究、采集数据、起草文章；彭雅婷：分析解释数据、起草文章、对文章的知识性内容作批评性审阅、支持性贡献；李静、林铃、宋庆、成玮：采集、分析、解释数据、统计分析；曾玉琴、陈平：酝酿和设计实验、对文章的知识性内容作批评性审阅、获取研究经费、支持性贡献

C

刘聪, 彭雅婷, 李静, 等. 慢性阻塞性肺疾病初诊患者流感和肺炎疫苗接种状况及影响因素：真实世界横断面研究[J]. 中华结核和呼吸杂志, 2022, 45(4): 355-361. DOI: 10.3760/cma.j.cn112147-20211019-00727.

D
所有作者声明无利益冲突
E
国家自然科学基金 (81770046)
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