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Article(id=1321170160518546333, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170080579301694, articleNumber=null, orderNo=null, doi=10.11847/zgggws1144202, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1707235200000, receivedDateStr=2024-02-07, revisedDate=1725552000000, revisedDateStr=2024-09-06, acceptedDate=1729612800000, acceptedDateStr=2024-10-23, onlineDate=1792921112422, onlineDateStr=2026-10-25, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921112422, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921112422, creator=13701087609, updateTime=1792921112422, updator=13701087609, issue=Issue{id=1321170080579301694, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='1', pageStart='1', pageEnd='128', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921093363, creator='13701087609', updateTime=1792921093363, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=68, endPage=72, ext={EN=ArticleExt(id=1321170160711484318, articleId=1321170160518546333, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=A retrospective cohort study on the protective effect of influenza vaccination during pregnancy on infants in Gansu province from 2018 to 2023, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the vaccine effectiveness (VE) of influenza vaccine (InfV) in pregnant women on their infants in Gansu province.

Methods

A total of 1 229 978 infants born to pregnant women in Gansu province from January 1, 2018 to December 31, 2023 were included in this study. Data were collected from the electronic medical record system, birth registration system, and immunization program system of Gansu province. A retrospective cohort of pregnant women who received InfV during pregnancy was constructed by linking the databases of each system through ID number. Information on laboratory-confirmed influenza cases in infants was collected through the electronic medical record system. Robust Poisson regression analysis was used to compare the adjusted risk ratio (RR), VE, and 95%confidence interval (CI) of influenza in infants born to pregnant women who received InfV during pregnancy and those who did not from 2018 to 2023.

Results

The incidence of influenza in infants born to 1 210 pregnant women who received InfV during pregnancy was 4.71% (57/1 210), which was significantly lower than 6.13% in infants born to 1 228 768 pregnant women who did not receive InfV during pregnancy (χ2=4, P<0.05). The adjusted RR was 0.78 (95%CI: 0.29–0.99), and the VE was 22.13% (95%CI: 0.79–40.30).

Conclusions

InfV vaccination during pregnancy provides some protection against influenza in infants under 6 months of age.

, authors=Xuefeng LIANG, Juanxia PENG, Di SUN, Bingling ZHANG, Jing AN, Yu TANG, Xiaoshu ZHANG, authorsList=Xuefeng LIANG, Juanxia PENG, Di SUN, Bingling ZHANG, Jing AN, Yu TANG, Xiaoshu ZHANG, authorCompany=null, correspAuthors=Xiaoshu ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Xiaoshu, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321170161483236259, articleId=1321170160518546333, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=2018—2023年甘肃省妊娠期孕妇接种流感疫苗对婴儿保护性效果回顾性队列研究, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

评价甘肃省妊娠期孕妇接种流感疫苗（InfV）对婴儿的疫苗保护效果（VE）。

方法

以甘肃省2018年1月1日—2023年12月31日1 229 978名妊娠期孕妇所分娩的6个月内婴儿作为研究对象，通过甘肃省电子病例系统、出生登记系统和免疫规划系统获取研究对象的相关数据，通过证件号码关联各系统数据库构建妊娠期孕妇接种InfV的回顾性队列；通过电子病例系统收集婴儿实验室确诊流感病例信息，采用稳健Poisson回归分析比较妊娠期孕妇InfV接种组和未接种组在2018—2023年其所分娩婴儿发生流感的调整风险比（RR）、VE及95%置信区间（CI）。

结果

妊娠期接种InfV的1 210名孕妇所分娩的婴儿流感发病率为4.71%（57/1 210），未接种InfV的1 228 768名孕妇所分娩的婴儿流感发病率为6.13%，差异有统计学意义（χ2=4，P<0.05）；调整RR值为0.78（95%CI=0.29～0.99），VE为22.13%（95%CI=0.79～40.30）。

结论

妊娠期孕妇接种InfV对6个月内婴儿具有一定的保护作用。

, authors=梁雪枫, 彭娟霞, 孙迪, 张秉玲, 安婧, 唐宇, 张晓曙*, *, authorsList=梁雪枫, 彭娟霞, 孙迪, 张秉玲, 安婧, 唐宇, 张晓曙, authorCompany=null, correspAuthors=张晓曙, authorNote=

梁雪枫（1983—），副主任医师，本科，研究方向：免疫规划与疾病预防控制

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张晓曙，E-mail：
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梁雪枫（1983—），副主任医师，本科，研究方向：免疫规划与疾病预防控制

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keyword=保护效果), Keyword(id=1321170163911738321, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, language=CN, orderNo=4, keyword=甘肃省)], refs=[Reference(id=1321170164482163670, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=1, rfOrder=0, authorNames=null, journalName=null, refType=null, unstructuredReference=Wang R T, Yan W X, Du M, et al. 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The Pediatric Infectious Disease Journal, 2010, 29(1): 6-9., articleTitle=null, refAbstract=null), Reference(id=1321170165757232103, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=null, journalName=null, refType=null, unstructuredReference=郜艳晖, 周舒冬, 李丽霞, 等. 基于相对危险度/患病率比的模型及参数估计方法研究进展[J]. 中华流行病学杂志, 2013, 34(9): 935-939., articleTitle=null, refAbstract=null), Reference(id=1321170165832729576, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=null, journalName=null, refType=null, unstructuredReference=Merckx J, Wali R, Schiller I, et al. 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The underrecognized burden of influenza in young children[J]. New England Journal of Medicine, 2006, 355(1): 31-40., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321170161730700196, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, xref=null, ext=[AuthorCompanyExt(id=1321170161739088805, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, companyId=1321170161730700196, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China), AuthorCompanyExt(id=1321170161747477414, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, companyId=1321170161730700196, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=甘肃省疾病预防控制中心，兰州 730000)])], figs=[ArticleFig(id=1321170164037567442, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, language=EN, label=Tab.1, caption=

Basic information of pregnant women and their delivered infants (<6 months old) in the InfV vaccination and non-vaccination groups in Gansu province, 2008–2023

, figureFileSmall=null, figureFileBig=null, tableContent=
变量接种组（n=1 210）构成比/%未接种组（n=1 228 768）构成比/%χ2值P值
分娩方式0.660.415
　顺产20116.61193 12415.72　　
　剖宫产1 00983.391 035 64484.28　　
婴儿是否患过流感4.000.045
　否1 15395.291 153 39493.87　　
　是574.7175 3746.13　　
产妇户籍0.000.989
　城市59148.84599 40948.78　　
　农村61951.16629 35951.22　　
产妇文化程度2.200.530
　小学151.2417 4791.42　　
　初中54144.71552 94945.00　　
　高中18114.96198 21716.13　　
　大学及以上47339.09460 12337.45　　
妊娠期高血压0.000.952
　否1 15895.701 175 02295.63　　
　是524.3053 7464.37　　
妊娠期糖尿病0.070.789
　否1 18497.851 204 19598.00　　
　是262.1524 5732.00　　
孕妇甲状腺患病史1.900.169
　否1 19398.601 204 18698.00　　
　是171.4024 5822.00　　
孕妇慢性呼吸系统疾病史1.700.187
　否1 20499.501 217 77599.11　　
　是60.5010 9930.89　　
孕妇神经系统疾病史0.010.910
　否1 20299.341 219 79799.27　　
　是80.668 9710.73　　
胎次39.00<0.001
　186271.24899 07173.17
　232626.94268 42921.85
　3221.8261 2684.99
婴儿性别0.530.468
　男63152.15627 46651.06
　女57947.85601 30248.94
), ArticleFig(id=1321170164121453523, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, language=CN, label=表1, caption=

2008－2023年甘肃省妊娠期InfV接种组和非接种组孕妇及所分娩婴儿（<6月龄）基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量接种组（n=1 210）构成比/%未接种组（n=1 228 768）构成比/%χ2值P值
分娩方式0.660.415
　顺产20116.61193 12415.72　　
　剖宫产1 00983.391 035 64484.28　　
婴儿是否患过流感4.000.045
　否1 15395.291 153 39493.87　　
　是574.7175 3746.13　　
产妇户籍0.000.989
　城市59148.84599 40948.78　　
　农村61951.16629 35951.22　　
产妇文化程度2.200.530
　小学151.2417 4791.42　　
　初中54144.71552 94945.00　　
　高中18114.96198 21716.13　　
　大学及以上47339.09460 12337.45　　
妊娠期高血压0.000.952
　否1 15895.701 175 02295.63　　
　是524.3053 7464.37　　
妊娠期糖尿病0.070.789
　否1 18497.851 204 19598.00　　
　是262.1524 5732.00　　
孕妇甲状腺患病史1.900.169
　否1 19398.601 204 18698.00　　
　是171.4024 5822.00　　
孕妇慢性呼吸系统疾病史1.700.187
　否1 20499.501 217 77599.11　　
　是60.5010 9930.89　　
孕妇神经系统疾病史0.010.910
　否1 20299.341 219 79799.27　　
　是80.668 9710.73　　
胎次39.00<0.001
　186271.24899 07173.17
　232626.94268 42921.85
　3221.8261 2684.99
婴儿性别0.530.468
　男63152.15627 46651.06
　女57947.85601 30248.94
), ArticleFig(id=1321170164318585812, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, language=EN, label=Tab.2, caption=

Protective effectiveness of influenza vaccination during pregnancy on infants and results of robust Poisson regression model analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量RR值95%CIZ值P值VE值95%CI
妊娠周期0.950.94～0.95−15.7090.0005.264.64～5.86
分娩方式1.041.02～10.063.7620.000−3.83−5.86～−1.84
产妇年龄0.990.98～0.99−8.9850.0000.660.52～0.81
户籍0.990.98～1.01−1.0290.3030.74−0.63～2.10
文化程度1.000.99～1.011.0230.306−0.48−1.38～0.41
妊娠期高血压1.051.02～1.092.9060.003−5.17−1.74～−8.67
妊娠期糖尿病0.980.93～1.03−0.9580.3372.49−2.45～7.29
甲状腺患病史1.030.99～1.091.3240.185−3.44−8.53～1.49
慢性呼吸系统疾病史0.990.92～1.06−0.3490.7271.34−6.12～8.46
神经系统疾病史1.020.94～1.100.4150.678−1.73−10.12～6.24
胎次1.071.06～1.0811.4630.000−7.44−8.76～−6.14
婴儿
　出生时体重0.850.84～0.87−19.100.00014.4113.03～15.77
　性别0.820.81～0.84−26.270.00017.0915.92～18.24
组别0.780.29～0.99−1.8910.05322.130.79～40.30
), ArticleFig(id=1321170164385694677, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170160518546333, language=CN, label=表2, caption=

妊娠期孕妇接种InfV对婴儿的保护效率及稳健Poisson回归模型分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量RR值95%CIZ值P值VE值95%CI
妊娠周期0.950.94～0.95−15.7090.0005.264.64～5.86
分娩方式1.041.02～10.063.7620.000−3.83−5.86～−1.84
产妇年龄0.990.98～0.99−8.9850.0000.660.52～0.81
户籍0.990.98～1.01−1.0290.3030.74−0.63～2.10
文化程度1.000.99～1.011.0230.306−0.48−1.38～0.41
妊娠期高血压1.051.02～1.092.9060.003−5.17−1.74～−8.67
妊娠期糖尿病0.980.93～1.03−0.9580.3372.49−2.45～7.29
甲状腺患病史1.030.99～1.091.3240.185−3.44−8.53～1.49
慢性呼吸系统疾病史0.990.92～1.06−0.3490.7271.34−6.12～8.46
神经系统疾病史1.020.94～1.100.4150.678−1.73−10.12～6.24
胎次1.071.06～1.0811.4630.000−7.44−8.76～−6.14
婴儿
　出生时体重0.850.84～0.87−19.100.00014.4113.03～15.77
　性别0.820.81～0.84−26.270.00017.0915.92～18.24
组别0.780.29～0.99−1.8910.05322.130.79～40.30
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2018—2023年甘肃省妊娠期孕妇接种流感疫苗对婴儿保护性效果回顾性队列研究
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梁雪枫 , 彭娟霞 , 孙迪 , 张秉玲 , 安婧 , 唐宇 , 张晓曙 *, *
中国公共卫生 | 调查报告与分析 2025,41(1): 68-72
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中国公共卫生 |调查报告与分析 2025 , 41 (1) : 68 -72
2018—2023年甘肃省妊娠期孕妇接种流感疫苗对婴儿保护性效果回顾性队列研究
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梁雪枫, 彭娟霞, 孙迪, 张秉玲, 安婧, 唐宇, 张晓曙*, *
作者信息
  • 甘肃省疾病预防控制中心，兰州 730000
通讯作者:
张晓曙，E-mail：
作者简介:

梁雪枫（1983—），副主任医师，本科，研究方向：免疫规划与疾病预防控制

A retrospective cohort study on the protective effect of influenza vaccination during pregnancy on infants in Gansu province from 2018 to 2023
Xuefeng LIANG, Juanxia PENG, Di SUN, Bingling ZHANG, Jing AN, Yu TANG, Xiaoshu ZHANG
Affiliations
  • Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China
    • Corresponding Author:
    ZHANG Xiaoshu, E-mail:
出版时间: 2025-01-10 doi: 10.11847/zgggws1144202
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摘要
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目的

评价甘肃省妊娠期孕妇接种流感疫苗（InfV）对婴儿的疫苗保护效果（VE）。

方法

以甘肃省2018年1月1日—2023年12月31日1 229 978名妊娠期孕妇所分娩的6个月内婴儿作为研究对象，通过甘肃省电子病例系统、出生登记系统和免疫规划系统获取研究对象的相关数据，通过证件号码关联各系统数据库构建妊娠期孕妇接种InfV的回顾性队列；通过电子病例系统收集婴儿实验室确诊流感病例信息，采用稳健Poisson回归分析比较妊娠期孕妇InfV接种组和未接种组在2018—2023年其所分娩婴儿发生流感的调整风险比（RR）、VE及95%置信区间（CI）。

结果

妊娠期接种InfV的1 210名孕妇所分娩的婴儿流感发病率为4.71%（57/1 210），未接种InfV的1 228 768名孕妇所分娩的婴儿流感发病率为6.13%，差异有统计学意义（χ2=4，P<0.05）；调整RR值为0.78（95%CI=0.29～0.99），VE为22.13%（95%CI=0.79～40.30）。

结论

妊娠期孕妇接种InfV对6个月内婴儿具有一定的保护作用。

妊娠期接种  /  流感疫苗  /  保护效果  /  甘肃省
Objective

To evaluate the vaccine effectiveness (VE) of influenza vaccine (InfV) in pregnant women on their infants in Gansu province.

Methods

A total of 1 229 978 infants born to pregnant women in Gansu province from January 1, 2018 to December 31, 2023 were included in this study. Data were collected from the electronic medical record system, birth registration system, and immunization program system of Gansu province. A retrospective cohort of pregnant women who received InfV during pregnancy was constructed by linking the databases of each system through ID number. Information on laboratory-confirmed influenza cases in infants was collected through the electronic medical record system. Robust Poisson regression analysis was used to compare the adjusted risk ratio (RR), VE, and 95%confidence interval (CI) of influenza in infants born to pregnant women who received InfV during pregnancy and those who did not from 2018 to 2023.

Results

The incidence of influenza in infants born to 1 210 pregnant women who received InfV during pregnancy was 4.71% (57/1 210), which was significantly lower than 6.13% in infants born to 1 228 768 pregnant women who did not receive InfV during pregnancy (χ2=4, P<0.05). The adjusted RR was 0.78 (95%CI: 0.29–0.99), and the VE was 22.13% (95%CI: 0.79–40.30).

Conclusions

InfV vaccination during pregnancy provides some protection against influenza in infants under 6 months of age.

vaccination during pregnancy  /  influenza vaccine  /  protective effect  /  Gansu province
梁雪枫, 彭娟霞, 孙迪, 张秉玲, 安婧, 唐宇, 张晓曙. 2018—2023年甘肃省妊娠期孕妇接种流感疫苗对婴儿保护性效果回顾性队列研究. 中国公共卫生, 2025 , 41 (1) : 68 -72 . DOI: 10.11847/zgggws1144202
Xuefeng LIANG, Juanxia PENG, Di SUN, Bingling ZHANG, Jing AN, Yu TANG, Xiaoshu ZHANG. A retrospective cohort study on the protective effect of influenza vaccination during pregnancy on infants in Gansu province from 2018 to 2023[J]. Chinese Journal of Public Health, 2025 , 41 (1) : 68 -72 . DOI: 10.11847/zgggws1144202
正文
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研究显示，妊娠期感染流感病毒可导致孕妇住院、严重疾病和死亡风险增高，可增加死产风险[1]，而妊娠期接种流感疫苗（influenza vaccine，InfV）可有效预防孕妇及所分娩的新生儿罹患流感[2]，避免流感样病例及因流感所致的早产、死产[3]，世界卫生组织（World Health Organization，WHO）积极推荐孕妇接种InfV[4]。但由于部分生产企业的InfV说明书将孕妇列为接种禁忌人群，致使孕妇InfV接种率很低[5]。甘肃省自2013年起不断完善覆盖全省的电子病例系统、出生登记系统和免疫规划信息等系统的建设，至2018年电子病例系统、出生登记系统和免疫规划信息系统已覆盖了全省各级医疗机构，成为医疗研究的重要资源[6]。链接已建的多个系统数据库资源，使评估妊娠期接种InfV的保护效果成为了可能。通过链接多个系统数据库进行回顾性队列研究，可以规避一些在前瞻性队列研究中常见的问题，特别是可以避免由于研究对象的拒绝参与或回忆偏倚而导致的数据不准确或数据缺失[7]。目前国内关于妊娠期接种InfV对婴儿保护作用的相关研究鲜有报道，本研究通过获取2018年1月1日—2023年12月31日（2018—2023年）甘肃省免疫规划信息系统、出生证明登记系统和电子病例系统数据构建妊娠期孕妇接种InfV的回顾性队列，分析妊娠期接种InfV对6个月内婴儿的保护效果，为妊娠期接种InfV提供科学依据。
1　对象与方法
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1.1　对象
研究对象为甘肃省2018年1月1日—2023年12月31日妊娠期孕妇及所分娩的6个月内婴儿，纳入标准：⑴免疫规划系统数据库具有有效的身份信息和接种信息；⑵电子病例系统具有门（急）诊或住院的医疗记录；⑶出生证明系统有新生儿出生体重、性别等出生信息。排除标准：妊娠期间接种了流感疫苗以外的其他疫苗的孕妇；妊娠期间接受免疫抑制剂治疗的孕妇。将纳入的孕妇按照妊娠期是否接种InfV分为接种组和未接种组。本研究已通过甘肃省疾病预防控制中心伦理审批（批准号：2023007）。
1.2　资料收集及研究方法
通过甘肃省免疫规划系统收集孕妇的人口学特征（年龄、户籍、文化程度、疫苗接种等）信息；通过甘肃省出生证明系统收集婴儿出生体重、性别等基本信息；通过电子病例系统收集孕妇胎次、分娩方式、疾病史及孕妇所分娩婴儿罹患流感等信息。通过证件号码关联各系统数据库构建妊娠期接种InfV的回顾性队列，进行回顾性队列研究，统计截止时间为2024年1月1日，结局为妊娠期接种InfV的孕妇所分娩的6个月内婴儿是否发生流感。
1.3　诊断标准
流感病例诊断标准：⑴发热（腋温≥38 ℃）；⑵实验室检测流感病毒特异核酸检测阳性或流感病毒抗原检测阳性。随访截止时间为婴儿>6月龄或至研究终止时间（2023年12月31日）。接种的流感疫苗限定为三价裂解流感疫苗或四价裂解流感疫苗。参照《国际疾病分类（第10版）》（international classification of diseases-10，ICD-10）编码[8]，从电子病例系统诊断病名中检索ICD-10编码为O13和O24的疾病分别确定妊娠期高血压和妊娠期糖尿病；通过甘肃省电子病例系统中的疾病史进行文本匹配，确定甲状腺疾病史、慢性呼吸系统疾病史和神经系统疾病史，若文本匹配结果存在，则将其判定为存在相应的疾病史。
1.4　统计分析
采用R 4.3.1（软件包主要是plm、robust 、stats和gtsummary）整理数据和进行统计分析。接种组与未接种组的基本特征定性资料比较采用χ2检验，定量资料比较采用t检验，计量数据采用$\bar x \pm s$表示；采用稳健Possion回归模型调整妊娠周期、户籍、分娩方式等因素后，估算接种InfV的RR值及其95%CI，进行稳健Poisson回归分析时，对存在年龄缺失值的个案，采取删除处理方式，检验水准$ \mathit{\alpha } $=0.05（双侧），VE=（1–RR）×100%。
2　结　果
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2.1　基本情况（表1）
本研究共纳入妊娠期孕妇1 229 978人，接种组和未接种组分别为1 210人、 1 228 768人，平均年龄分别为（29.95±4.31）、（28.25±4.88）岁，妊娠周期分别为（38.98 ±0.98）、（38.96±1.01）周，婴儿出生时体重分别为（3.27±0.41）、（3.26±0.45）kg，多数为头胎（分别占71.24%、73.17%），2组孕妇除平均年龄、妊娠周期、分娩方式差异有统计学意义（t=14、t=0.76、χ2=0.66，P均<0.05）外，户籍、文化程度等差异均无统计学意义（P均>0.05）。2组孕妇分娩婴儿在出生时体重、胎次、性别差异均有统计学意义（t=0.70、χ2=39、χ2=0.53，P均<0.05）。未接种组婴儿流感发病率（6.13%）明显高于接种组（4.71%），差异有统计学意义（χ2=4，P<0.05）。
2.2　妊娠期接种InfV对婴儿的保护效果及稳健Poisson回归模型分析结果（表2）
调整妊娠周期、户籍、分娩方式等因素后，接种组与未接种组孕妇RR值为0.78（95%CI=0.29～0.99），VE为22.13%（95%CI=0.79～40.30）。稳健 Possion 回归模型分析结果显示，剖宫产、妊娠期高血压、多胎次RR值均>1，差异有统计学意义（P均<0.05）；妊娠周期、产妇年龄、婴儿出生时体重、婴儿性别RR值均<1，差异有统计学意义（P均<0.05）。
3　讨　论
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国外的研究显示，妊娠期接种InfV的孕妇所分娩的婴儿可降低48%的流感风险[9]，降低72%的住院风险[10]；孕妇接种InfV后产生的抗流感病毒抗体可通过胎盘传递给婴儿，从而减少婴儿罹患流感的风险，为婴儿在出生后的几个月提供了保护作用[11]。《中国流感疫苗接种指南（2022—2023）》[2]建议孕妇可在妊娠任何阶段接种InfV，但由于目前我国InfV为自费疫苗（居民自费并且自愿接种的疫苗），且上市的部分InfV说明书仍将孕妇列为接种禁忌等原因，致使妊娠期孕妇InfV接种率低[5]，也因此限制了妊娠期接种InfV效果的前瞻性队列研究。
本研究采用回顾性队列研究方法，结果显示，妊娠期孕妇接种InfV组所分娩的6个月内婴儿流感发病率（4.71%）明显低于未接种组（6.13%）。通过稳健Possion回归模型调整妊娠周期、户籍、分娩方式等因素后，RR值为0.78，VE为22.13%（95%CI=0.79～40.30）。χ2检验显示2组间婴儿流感发病率差异有统计学意义（χ2=4，P=0.045），但在进一步通过稳健Poisson回归模型调整相关因素后，Z=–1.891，P=0.053。P值是评估统计学差异是否有统计学意义的常用指标，但其并不能完全反映结果的实际意义[12]。在综合考虑效应大小和其他既往研究的结果[13]，可以认为妊娠期接种InfV对降低婴儿患流感风险具有一定的保护作用。
本研究所得RR值高于Shakib J H等[14]研究结果[RR 为0.33（95%CI=0.21～0.52）]，一是，Shakib等[14]采用的前瞻性队列研究可减少选择偏倚的影响，本研究采用的回顾性队列研究虽减少了回忆偏倚，但因无法随机分组和可能存在未测量的因素等原因仍存在选择偏倚和混杂偏倚；二是，2个研究开展的时间不同，流感病毒流行株的变异可导致研究结果的不同。
本研究还显示，剖宫产、妊娠期高血压、多胎次均为婴儿发生流感的高危因素。早在2017年，Liao S L等[15]研究就发现剖宫产可增加婴儿呼吸道感染的风险，但其机制尚不完全清楚。妊娠期高血压可能导致胎盘功能不全，影响营养物质和氧气向胎儿输送，从而影响胎儿免疫系统的发育，降低婴儿抵抗流感病毒的能力[16]。多胎次为婴儿流感风险的原因很可能是婴儿的同胞长兄长姐将在学校、幼儿园等场所感染的流感病毒带回家中传染给了婴儿。此外，婴儿阶段，特别出生后1～3月内免疫系统尚未形成[17]。
由于本研究中InfV接种组人数较未接种组少，因此不排除在其他特征或因素方面存在差异而导致出现选择偏倚，使2组之间的比较结果不准确或有误导性。目前甘肃省的电子病例信息有限，大部分就诊信息为文本结果，未能全部整理成为结构化数据，导致缺乏对妊娠期孕妇及其所分娩婴儿之外影响因素的了解，也不排除存在潜在的混杂因素。本研究为回顾性队列研究，变量中有多分类变量和定量变量，采用稳健Possion回归模型对多分类变量和定量变量进行了估算，但该模型的分析结果无法用于预测[18]；同时，由于是对甘肃省不同医疗机构、不同时期的回顾性研究，涉及的范围广和时间跨度较大，对流感病例的确诊检测方法不统一性，与核酸检测比较，流感抗原检测的灵敏度和特异性存在不足[19]，对婴儿保护性研究的结果具有一定的局限性。
婴儿免疫系统尚不成熟，目前无法直接对6个月内婴儿进行InfV的免疫接种[20]。以往研究表明，妊娠期接种InfV不但对婴儿具有保护作用[2]，而且具有明显的成本效用[21]。因此，建议将妊娠期接种InfV纳入免费规划并将InfV疫苗说明书中的孕妇禁忌取消，对婴儿提供广泛保护的同时，可降低流感相关疾病的风险。

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doi: 10.11847/zgggws1144202
  • 接收时间：2024-02-07
  • 首发时间：2026-10-25
  • 出版时间：2025-01-10
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  • 收稿日期：2024-02-07
  • 修回日期：2024-09-06
  • 录用日期：2024-10-23
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    甘肃省疾病预防控制中心，兰州 730000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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