Анализ влияния вакцинопрофилактики пневмококковой инфекции у пациентов с хронической обструктивной болезнью легких в сочетании с сахарным диабетом
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Ignatova G.L., Blinova E.V., Antonov V.N., Grebneva I.V. Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes. Therapeutic Archive. 2019; 91 (11): 49–54. DOI: 10.26442/00403660.2019.11.000424
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Материалы и методы. В исследование включено 309 пациентов с изолированным течением ХОБЛ и в комбинации с СД. Основными параметрами для оценки эффективности являлась динамика клинических симптомов: одышка по шкале mMRC, оценочный тест ХОБЛ по САТ-тесту, объем форсированного выдоха за 1-ю секунду, количество обострений, госпитализаций, число пневмоний, состояние углеводного обмена (HbA1c) и липидного профиля. Для вакцинопрофилактики использовалась 13-валентная конъюгированная пневмококковая вакцина Превенар-13 (ПКВ-13).
Результаты и заключение. Применение ПКВ-13 способствует уменьшению тяжести респираторных симптомов, сокращению числа и длительности обострений ХОБЛ, снижению количества пневмоний как при изолированном течении ХОБЛ, так и при сочетании с СД. Вакцинация Превенар-13 у пациентов с коморбидным течением способствует компенсации углеводного обмена и улучшению липидного профиля.
Ключевые слова: хроническая обструктивная болезнь легких, сахарный диабет, вакцинопрофилактика, конъюгированная вакцина.
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Aim. The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow-up period.
Materials and methods. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms – shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used.
Results and conclusions. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.
Keywords: chronic obstructive pulmonary disease, diabetes, vaccine prevention, conjugated vaccine.
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1. Global Initiative for Chronic Obstructive Lung Disease, GOLD, 2018. аvailable at: http://www.goldcopd.org
2. [Romashov BB, Polyakova NV. Features of pathogenesis, clinic and treatment of a combination of chronic obstructive pulmonary disease and diabetes mellitus. Young scientist. 2015;13:310-4 (In Russ.)].
3. Couillard A, Veale D, Muir JF. Comorbidities in COPD: a new challenge in clinical practice. Rev Pneumol Clin. 201;67(3):143-53. doi: 10.1016/j.pneumo.2010.05.003
4. [Algorithms of specialized medical care for patients with diabetes mellitus: clinical guidelines. Issue 8. II Dedov, MV Shestakova, AYu Mayorov, ed. Moscow, 2017 (In Russ.)].
5. Kornum JB, Thomsen RW, Riis A. Diabetes, glycemic control, and risk of hospitalization with pneumonia: apopulation-basedcase-controlstudy. Diabetes Care. 2008;3:1541-5. doi: 10.2337/dc08-0138
6. Liu J. Impact of diabetes mellitus on pneumonia mortality in a senior population: results from the NHANES III follow-up study. Geriatr Cardiol. 2013;3:267-71. doi: 10.3969/j.issn.1671-5411.2013.03.005
7. [Shoykhet YaN, Titova EA, Algazin AI, et al. Features of the course of chronic obstructive pulmonary disease in patients with diabetes mellitus. Pulmonology. 2008;5:60-5 (In Russ.)].
8.[Filatova YI, Perfileva MV, Chernov AV. Features of the clinic and treatment of chronic obstructive pulmonary disease on the background of metabolic syndrome. Young scientist. 2014;7: 220-2 (In Russ.)].
9. [Shakhmalova MSh, Chugunova LA. Urinary tract infections in patients with diabetes mellitus: diagnosis, prevention, treatment. Diabetes. 2001;3:24-9 (In Russ.)].
10. Moutschen M. Alterations in natural immunity and risk of infection in patients with diabetes mellitus. Rev Med Liege. 2005;60(5-6):541-4.
11. Clement S, Braithwaite SS, Magel MF, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553-91. doi: 10.2337/diacare.27.2.553
12. Liberatore RR, Jr, Barbosa SF, Alkimin MG. Is immunity in diabetic patients influencing the susceptibitity to infectous? Immunoglobulins, complement and phagocytic function in children and adolescent with type 1 diabetes mellitus. Pediatr Diabetes. 2005;64(4):206-12. doi: 10.1111/j.1399-543X.2005.00136.x
13. [Zhuk EA. Changes in immunological parameters in diabetic ketoacidosis. Actual problems of modern endocrinology: Proceedings of the IV All-Russian Congress of Endocrinologists. SPb., 2001:68 (In Russ.)].
14. Geerlings SE, Hoepelman AJ. Immune dysfunction in patients with diabetes mellitus. FEMS Immunol Med Microb. 1999;26(3-4):259-65. doi: 10.1111/j.1574-695X.1999.tb01397.x
15. Smitherman KO, Peacock JE Jr. Infectious emergenies in patients with diabetes mellitus. Med Clin North Am. 1995;79(1):53-77. doi: 10.1016/s0025-7125(16)30084-0
16. McManus LM, Bloodworth RC, Prihoda TJ, et al. Agonist-dependent failure of neutrophil function in diabetes correlates with extent of hyperglycemia. J Leukoc Biol. 2001;70(3):395-404.
17. Weekers F, Giulietti AP, Michalaki M, et al. Metabolic, endocrine, and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology. 2003;144(12):5329-38. doi: 10.1210/en.2003-0697
18. [Kostinov MP, Tarasova AA. Recommendations for vaccination of children with diabetes. Epidemiology and Vaccination. 2015;81(2):101-6 (In Russ.)]. doi: 10.31631/2073-3046-2015-14-2-101-101
19. Chuchalin AG, Ametov AS, Kostinov MP, Briko NI, Snegova NF, Galitskaya MG, et al. Current approaches to the vaccination of pneumococcal infection in adult patients at risk. Endocrinology: news, opinions, training. 2013;1:85-8 (In Russ.)].
20. [Kostinov MP, Tarasova AA. Recommendations for vaccination of children with diabetes. Epidemiology and Vaccination. 2014;6(79):104-5 (In Russ.)]. doi: 10.31631/2073-3046-2015-14-1-88-89
21. [Rudakova AV, Baranov AA, Lobzin YuV, Briko NI, Namazova-Baranova LS, Tatochenko VK. Pharmacoeconomic aspects of vaccination of 13-valent pneumococcal conjugate vaccine in children in the Russian Federation. Questions of modern pediatrics. 2014; 1:51-9 (In Russ.)].
22. [Chuchalin AG, Bilichenko TN, Zverev VV, Semenov BF, Kostinov MP, Tatochenko VK. and others. Immunization with polysaccharide polyvalent vaccine for the prevention of pneumococcal infection. Guidelines. Moscow, 2008 (In Russ.)].
23. [Federal guidelines for the use of medicines (formulary system, reference book). Release XVII. AG Chuchalin, VV Yasnetsov, ed. Moscow: LLC "Vidox", 2016 (In Russ.)].
24. [Kostinov MP, Lavrov VF. Vaccines of the new generation in the prevention of infectious diseases. 2nd edition, supplemented. Moscow: MIA, 2010 (In Russ.)].
25. Webber C, Patton M, Patterson S, Schmoele-Thoma B, Huijts SM, Bonten MJ. CAPiTA Study Group Exploratory efficacy endpoints in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Vaccine. 2017;35(9):1266-72. doi: 10.1016/j.vaccine.2017.01.032
26. Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;19:1114-25. doi: 10.1056/nejmoa1408544
27. Huijts SM, van Werkhoven CH, Bolkenbaas M, Grobbee DE, Bonten MJ. Post-hoc analysis of a randomized controlled trial: Diabetes mellitus modifies the efficacy of the 13-valent pneumococcal conjugate vaccine in elderly. Vaccine. 2017;34:4444-9. doi: 10.1016/j.vaccine.2017.01.071
28. [Vertkina AL. The role of chronic systemic inflammation in the development of comorbidity in COPD. Emergency doctor. 2013;(3):36-48 (In Russ.)].
29. Hadi HAR, Suwaidi JAI. Endothelial dysfunction in diabetes mellitus. Vascular Health and Risk management. 2007;3(6):853-76.
30. Park SK, Larson JL. Metabolic syndrome and associated factors in people with chronic obstructive pulmonary disease. West J Nurs Res. 2014;36(5):620-42. doi: 10.1177/0193945913512423
31. Rabe KF, Wedzicha JA, Wouters EFM. COPD and Comorbidity. Eur Respir Soc Monograph. 2013. doi: 10.1183/1025448x.erm5913
32. Shashank RJ, Samika SJ, Siddharth NS. Pneumococcal Vaccine in Diabetes: Relevance in India. J Assoc Physicians India. 2015;63(4 Suppl):S34-S35.
33. [Kostinov MP. Tarasova AA. Vaccine prevention of pneumococcal infection and influenza in autoimmune diseases: A guide for physicians. Moscow, 2009:252 p (In Russ.)].
34. [Clinical and immunological effectiveness of immunobiological preparations. Ed. MP Kostinova, NA Ozeretskovsky. Moscow, 2004:256 p (In Russ.)].
35. [Ignatova GL, Antonov VN, Rodionova OV. Economic evaluation of vaccine prophylaxis of chronic obstructive pulmonary disease and coronary heart disease. Pulmonology. 2015;25(3): 312-9 (In Russ.)]. doi: 10.18093/0869-0189-2015-25-3-312-319
ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, кафедра терапии института дополнительного профессионального образования, Челябинск, Россия
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G.L. Ignatova, E.V. Blinova, V.N. Antonov, I.V. Grebneva
South Ural State Medical University, Department of Therapy Institute of Additional Professional Education, Chelyabinsk, Russia