带状疱疹活疫苗对2型糖尿病患者的有效性：一项全国性的模拟目标试验

IF 8.5 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2025-05-09 DOI:10.1016/j.cmi.2025.05.003

Tae Hyeon Kim , Kyeongmin Lee , Sooji Lee , Jiyeon Oh , Jaeyu Park , Hyesu Jo , Yejun Son , Soeun Kim , Sang Youl Rhee , Lee Smith , Hanseul Cho , Junyang Jung , Seung Geun Yeo , Hayeon Lee , Dong Keon Yon

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引用次数: 0

摘要

目的：关于其对2型糖尿病（T2DM）患者有效性的实际研究仍然有限。本研究旨在评估带状疱疹活疫苗在10年以上T2DM患者中的有效性。方法：在这项目标试验模拟研究中，我们利用了韩国一个大规模的全国性队列，包括2012年1月1日至2021年12月31日期间年龄在50岁及以上的T2DM患者（n=934,945）。该队列综合了来自韩国健康保险审查和评估服务中心的健康保险数据，来自韩国国民健康保险服务中心的国民健康筛查结果，以及来自韩国疾病控制和预防机构的带状疱疹活疫苗接种数据。在T2DM患者中评估了疫苗在预防HZ、带状疱疹后神经痛和基于ICD-10编码的HZ住院率方面的有效性。在基于倾向评分的重叠加权队列中，使用Cox比例风险模型来评估2型糖尿病患者带状疱疹活疫苗有效性的调整风险比（aHRs）和95%保密区间（CIs）。结果：基于倾向评分的重叠加权后，纳入253,660例T2DM患者(平均年龄62.4岁[标准差2.3岁]；138,338名男性，54.5%)。带状疱疹活疫苗接种与HZ （aHR, 0.59 [95% CI, 0.57-0.61]）、带状疱疹后神经痛（aHR, 0.59 [95% CI, 0.57-0.61]）和HZ住院（aHR, 0.41 [95% CI, 0.36-0.47]）的风险降低相关。疫苗的效力在接种后的第一年内最高，其持续保护作用可持续长达六年。此外，非胰岛素治疗组的有效性高于胰岛素治疗组。结论：我们的目标试验强调，带状疱疹活疫苗接种可显著降低2型糖尿病患者HZ、带状疱疹后神经痛和住院的风险。然而，在接受胰岛素治疗的患者中，其有效性减弱。

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Effectiveness of the live zoster vaccine in patients with type 2 diabetes: a nationwide emulated target trial

Objectives

Real-world studies on its effectiveness in patients with type 2 diabetes mellitus (T2DM) remain limited. This study aimed to evaluate the effectiveness of the live zoster vaccine in patients with T2DM more than 10 years.

Methods

In this target trial emulation study, we utilized a large-scale, nationwide cohort in South Korea, consisting of individuals aged 50 years and older with T2DM from January 1, 2012 to December 31, 2021 (n = 934 945). This cohort was integrated using health insurance data from the Korea Health Insurance Review and Assessment Service, national health screening results from the Korean National Health Insurance Service, and live zoster vaccination data from the Korea Disease Control and Prevention Agency. Vaccine effectiveness in preventing herpes zoster (HZ), postherpetic neuralgia, and hospital admissions for HZ based on International Classification of Diseases 10th edition codes was evaluated in patients with T2DM. In a propensity score-based overlap weighted cohort, Cox proportional hazard models were used to evaluate the adjusted hazard ratios (aHRs) and 95% CIs for the effectiveness of the live zoster vaccine among patients with T2DM.

Results

After propensity score-based overlap weighting, 253 660 patients with T2DM were included (mean age, 62.4 years [standard deviation, 2.3 years]; 138 338 males, 54.5%). Live zoster vaccination was associated with a reduced risk of HZ (aHR 0.59 [95% CI: 0.57–0.61]), postherpetic neuralgia (aHR 0.59 [95% CI: 0.57–0.61]), and hospital admissions for HZ (aHR 0.41 [95% CI: 0.36–0.47]). Vaccine effectiveness was highest within the first-year post-vaccination, with a sustained protective effect lasting up to 6 years. Furthermore, the effectiveness was greater in the non-insulin treatment group compared with the insulin treatment group.

Discussion

: Our target trial highlighted that live zoster vaccination significantly reduced the risk of HZ, postherpetic neuralgia, and hospital admissions in patients with T2DM. However, its effectiveness was attenuated in those undergoing insulin treatment.

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.