目的 系統(tǒng)評(píng)價(jià)大劑量布地奈德治療慢性阻塞性肺病急性加重期（AECOPD）的療效和安全性，為臨床合理用藥提供參考。方法 檢索Cochrane Library、PubMed、Embase、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）等專(zhuān)業(yè)數(shù)據(jù)庫(kù)，收集大劑量布地奈德（試驗(yàn)組）對(duì)比常規(guī)劑量布地奈德（對(duì)照組）治療AECOPD的隨機(jī)對(duì)照試驗(yàn)（RCT），時(shí)間從建庫(kù)到2019年5月。提取相關(guān)資料并評(píng)價(jià)文獻(xiàn)質(zhì)量，使用RevMan 5.3軟件進(jìn)行Meta-分析。結(jié)果 共納入12項(xiàng)RCTs，878例患者。Meta-分析結(jié)果顯示，試驗(yàn)組患者在改善臨床癥狀評(píng)分［MD=-1.00，95% CI（-1.44，-0.56），P<0.01］、升高動(dòng)脈血氧分壓（PaO₂）［MD=5.71，95% CI（5.03，6.38），P<0.01］、降低動(dòng)脈血二氧化碳分壓（PaCO₂）［MD=-5.75，95% CI（-7.24，-4.26），P<0.01］、升高1 s用力呼氣量（FEV1）［MD=0.20，95% CI（0.10，0.30），P<0.01］及FEV1占用力肺活量（FVC）的百分比（FEV1/FVC）［MD=5.69，95% CI（1.46，9.91），P<0.01］均顯著優(yōu)于對(duì)照組。但試驗(yàn)組患者口腔真菌發(fā)生率［RR=3.18，95% CI（1.18，8.55），P=0.02］也顯著大于對(duì)照組。結(jié)論 大劑量布地奈德治療AECOPD與常規(guī)劑量相比，臨床療效更優(yōu)，但增加口腔真菌感染的風(fēng)險(xiǎn)。

Objective To systematically evaluate the efficacy and safety of high-dose budesonide on acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to provide a reference for the rational drug use. Methods Retrieved from the Cochrane Library, PubMed, Embase, Wanfang, CNKI and CMB database from the inception to May 2019, randomized controlled trials (RCTs) about of high-dose budesonide (test group) compared with conventional-dose budesonide (control group) in the treatment of AECOPD was collected. After the data extraction and evaluation quality of RCTs, Meta-analysis was conducted by using RevMan 5.3 software. Results A total of 12 RCTs were included, involving 878 patients. Meta-analysis showed that improving clinical symptom scores[MD=-1.00, 95%CI(-1.44, -0.56), P<0.01], elevated PaO₂[MD=5.71, 95%CI(5.03, 6.38), P<0.01], lower PaCO₂[MD=-5.75, 95%CI(-7.24,-4.26), P<0.01], increase FEV1[MD=0.20, 95%CI(0.10, 0.30), P<0.01] and FEV1/FVC(%)[MD=5.69, 95%CI(1.46, 9.91), P<0.01] of test group were significantly better than that of the control group. But oral fungal infections rate of test group[RR=3.18, 95%CI(1.18, 8.55), P=0.02] were significantly higher than that of the control group. Conclusion High-dose budesonide has better clinical efficacy compared with conventional-dose of budesonide in the treatment of AECOPD. But increase the risk of oral fungal infections.

R974;R977.1