流感疫苗可以预防急性心肌梗死？

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目前急性心肌梗死（AMI）是全球主要的致死致残性疾病。越来越来的观察性研究表明，流感病毒感染与AMI息息相关；对有冠状动脉疾病的患者，使用流感疫苗可以降低心血管事件发生风险。研究者进行了一项病例对照研究的荟萃分析，探究对于全人类流感的病毒感染或流感病毒疫苗和AMI发生的关系。

该研究共纳入了16篇病例对照文章，8项研究是关于流感疫苗与AMI，有10项流感病毒感染和AMI的研究。

研究数据显示，新感染流感病毒、流感样疾病或呼吸道感染更常见于AMI患者（OR=2.01，95% CI 1.47 to 2.76）。流感疫苗也与AMI明显相关（OR=0.71，95% CI 0.56 to 0.91）；或者说流感疫苗抵抗AMI发生的有效性为29%(95% CI 9% to 44%) 。

该荟萃分析表明新近呼吸道感染与AMI密切相关。流感疫苗对AMI发生的保护作用的有效性，可与目前临床上公认的AMI二级预防数据相媲美。关于流感疫苗与AMI之间的关系以后还需要更多更大的随机对照试验。

来源：MedSci

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Acute myocardial infarction and influenza: a meta-analysis of case-control studies.

Barnes M1, Heywood AE1, Mahimbo A1, Rahman B1, Newall AT1, Macintyre CR1.

OBJECTIVE:
Acute myocardial infarction (AMI) is the leading cause of death and disability globally. There is increasing evidence from observational studies that influenza infection is associated with AMI. In patients with known coronary disease, influenza vaccination is associated with a lower risk of cardiovascular events. However, the effect of influenza vaccination on incident AMI across the entire population is less well established.

METHOD:
The purpose of our systematic review of case-control studies is twofold: (1) to estimate the association between influenza infection and AMI and (2) to estimate the association between influenza vaccination and AMI. Cases included those conducted with first-time AMI or any AMI cases. Studies were appraised for quality and meta-analyses using random effects models for the influenza exposures of infection, and vaccination were conducted.

RESULTS:
16 studies (8 on influenza vaccination, 10 on influenza infection and AMI) met the eligibility criteria, and were included in the review and meta-analysis. Recent influenza infection, influenza-like illness or respiratory tract infection was significantly more likely in AMI cases, with a pooled OR 2.01 (95% CI 1.47 to 2.76). Influenza vaccination was significantly associated with AMI, with a pooled OR of 0.71 (95% CI 0.56 to 0.91), equating to an estimated vaccine effectiveness of 29% (95% CI 9% to 44%) against AMI.

CONCLUSIONS:
Our meta-analysis of case-control studies found a significant association between recent respiratory infection and AMI. The estimated vaccine effectiveness against AMI was comparable with the efficacy of currently accepted therapies for secondary prevention of AMI from clinical trial data. A large-scale randomised controlled trial is needed to provide robust evidence of the protective effect of influenza vaccination on AMI, including as primary prevention.

http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=26310262