方法：本项队列研究纳入2005年1月1日-2009年8月31日列入全国健康计划的50岁及以上的类风湿关节炎、银屑病、银屑病关节炎、强直性脊柱炎以及炎症性肠病患者。调查使用带状疱疹疫苗的范围和种类，评价与疫苗使用的相关因素，比较使用和未使用疫苗患者的带状疱疹发生率。

结果：在44115例自身免疫性疾病患者中，551例接种了带状疱疹疫苗，共有761例发生了带状疱疹。带状疱疹疫苗自2006年被批准以来其临床应用逐渐增多。年轻和健康患者、6个月内感染过带状疱疹、以及那些未使用抗TNF制剂治疗的患者更倾向于接种疫苗。大约有6%的患者在接种疫苗时正接受抗TNF制剂治疗。接种疫苗和未接种疫苗患者带状疱疹的发生率相似（标准化发病比，0.99， 95% CI 0.29 -3.43）。

结论：自身免疫性疾病的老年患者使用带状疱疹疫苗并不普遍，包括那些未使用免疫抑制剂的患者。接种疫苗患者短期带状疱疹的发生风险并未增加，即便是那些在接种时使用免疫抑制剂治疗的患者。由于病例数较少，我们的研究尚具有局限性，还需要更多的证据确定该疫苗的安全性和有效性。

附原文 Abstract INTRODUCTION: Zostavax, a live attenuated vaccine, has been approved in the US for use in older individuals to reduce risk and severity of herpes zoster (HZ), also known as shingles. The vaccine is contraindicated in individuals taking anti-tumor necrosis factor alpha (anti-TNF) therapies or other biologics commonly used to treat autoimmune diseases due to the safety concern that zoster vaccine may be associated with a short-term HZ risk. The objective of the study was to examine the use, safety (short-term HZ risk after vaccination), and effectiveness of zoster vaccine in individuals with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and/or inflammatory bowel diseases. METHODS: We conducted a cohort study of patients aged 50 years and older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and/or inflammatory bowel diseases using administrative claims data from a nationwide health plan from January 1st 2005 to August 31st 2009. We examined the extent to which zoster vaccine was used; assessed factors associated with vaccine use (Cox proportional hazards regression); and compared the incidence rates of herpes zoster (HZ) between vaccinated and unvaccinated patients. RESULTS: Among 44,115 patients with the autoimmune diseases, 551 (1.2%) received zoster vaccine and 761 developed HZ. Zoster vaccine use increased continuously after approval in 2006. Younger and healthier patients, those who had a HZ infection within the past 6 months, and those who were not using anti-TNF therapies were more likely to receive the vaccine. Approximately 6% of vaccinated patients were using anti-TNF therapies at the time of vaccination. The incidence rates of HZ were similar in vaccinated and unvaccinated patients (standardized incidence ratio, 0.99; 95% confidence interval, 0.29 to 3.43). CONCLUSIONS: Use of the zoster vaccine was uncommon among older patients with autoimmune diseases, including those not exposed to immunosuppressive medications. The short-term risk of HZ did not appear to be increased in vaccinated patients, even among those using immunosuppressive therapies (e.g. biologics) at the time of vaccination. However, our study was limited by the small number of vaccinated patients, and further evidence is needed to confirm the vaccine's safety and efficacy in this population.

引自：Zhang J, Delzell ES, Xie F, Baddley JW, Spettell C, McMahan RM, Fernandes J, Chen L, Winthrop K, Curtis JR. The use, safety and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study. Arthritis Res Ther. 2011 Oct 24;13(5):R174