目的 系統(tǒng)評價免疫球蛋白治療新生兒感染性肺炎的療效、安全性，及對免疫功能的影響。方法 計算機檢索PubMed、EMbase、The Cochrane Library、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫（CBM）和維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，檢索年限為從建庫至2020年4月，搜集免疫球蛋白治療新生兒感染性肺炎的臨床隨機對照試驗（RCT），篩選文獻后提取數(shù)據(jù)，采用Jadad量表進行文獻質(zhì)量評價，通過RevMan 5.3軟件對臨床有效率、臨床體征改善時間、血氣分析指標(biāo)、炎性因子指標(biāo)、免疫球蛋白水平、T淋巴細(xì)胞水平和不良反應(yīng)發(fā)生率進行Meta-分析。結(jié)果 共納入13項研究，1 185例患者。Meta-分析結(jié)果顯示：試驗組（免疫球蛋白）的臨床有效率比對照組高[RR=1.19，95%CI（1.13，1.24），P<0.01]；退熱時間[MD=-1.45，95%CI（-1.58，-1.32）]、咳嗽咳喘消失時間[MD=-2.06，95%CI（-2.23，-1.89）]、肺部啰音消失時間[MD=-1.85，95%CI（-2.00，-1.69）]和住院時間[MD=-2.37，95%CI（-2.59，-2.16）]均顯著小于對照組（P<0.01）；氧氣分壓（PO₂）提高[MD=2.31，95%CI（1.56，2.89）]、二氧化碳分壓（PCO₂）下降[MD=-1.49，95%CI（-2.01，-0.97）]和動脈血氧飽和度（SaO₂）提高[MD=1.08，95%CI（0.46，1.70）]均顯著優(yōu)于對照組（P<0.01）；降鈣素原下降[SMD=-1.39，95%CI（-2.48，-0.31）]和C-反應(yīng)蛋白下降[SMD=-1.85，95%CI（-2.87，-0.84）]均優(yōu)于對照組（P<0.01）；免疫球蛋白IgG水平升高[SMD=1.80，95%CI（1.39，2.20）]顯著優(yōu)于對照組（P<0.01）；CD3⁺增加值[MD=2.13，95%CI（1.08，3.19）]、CD4⁺增加值[MD=3.97，95%CI（2.88，5.06），P<0.01]、CD8⁺增加值[MD=1.33，95%CI（0.25，2.90），P=0.01]和CD4⁺/CD8⁺增加值[MD=0.33，95%CI（0.03，0.63），P=0.03]均顯著優(yōu)于對照組；不良反應(yīng)發(fā)生率與對照組相當(dāng)[RR=1.16，95%CI（0.57，2.35），P=0.69]。結(jié)論 免疫球蛋白能迅速減輕新生兒感染性肺炎臨床癥狀、顯著改善血氧含量、炎性因子水平和免疫功能，且安全性較好。

objective To evaluate the clinical efficacy and immune function of immunoglobulin (IVIG) in the treatment of neonatal infectious pneumonia. Methods The databases of PubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and Wanfang Data were searched for randomized controlled trials (RCTs) of immunoglobulin in the treatment of neonatal infectious pneumonia from database establishment to April of 2020. According to the inclusion and exclusion criteria, data were extracted and Jadad scale was used to evaluate the quality of literature. Meta-analysis was performed for clinical effective rate, improvement time of clinical signs, blood gas analysis index, inflammatory factor index, immunoglobulin level, T lymphocyte level and incidence of adverse reactions by using RevMan 5.3 statistical software. Results A total of 13 RCTs were included, involving 1 185 patients. Meta-analysis showed that the clinical effective rate of the experimental group (immunoglobulin group) was higher than that of the control group[RR=1.19, 95%CI (1.13, 1.24), P<0.01]; the fade time[MD=-1.45, 95%CI (-1.58, -1.32)], time of cough and asthma abatement[MD=-2.06, 95%CI (-2.23, -1.89)], time of lung rale abatement[MD=-1.85, 95%CI (-2.00, -1.69] and hospitalization[MD=-2.37, 95%CI (-2.59, -2.16)] were significantly shorter than those of the control group (P<0.01); PO₂ increased[MD=2.31, 95%CI (1.56, 2.89)], PCO₂ decreased[MD=-1.49, 95%CI (-2.01, -0.97)] and Increased SaO₂[MD=1.08, 95%CI (0.46, 1.70)] were significantly better than those of the control group (P<0.01); PCT decreased[SMD=-1.39, 95%CI (-2.48, -0.31] and decreased CRP[SMD=-1.85, 95%CI (-2.87, -0.84)] were superior than those of the control group (P<0.01); IgG increased[SMD=1.80, 95%CI (1.39, 2.20), P<0.01] was significantly better than the control group; CD3⁺ increased[MD=2.13, 95%CI (1.08, 3.19), P<0.01], CD4⁺ increased[MD=3.97, 95%CI (2.88, 5.06), P<0.01], CD8⁺ increased[MD=1.33, 95%CI (0.25, 2.90), P=0.01] and CD4⁺/CD8⁺ increased[MD=0.33, 95%CI (0.03, 0.63), P=0.03] were significantly better than those of the control group. The incidence of adverse reactions was comparable to the control group[RR=1.16, 95%CI (0.57, 2.35), P=0.69]. Conclusion Evidence-based studies shows that immunoglobulin can quickly reduce the clinical symptoms of neonatal infectious pneumonia, significantly improve blood oxygen content, inflammatory factor levels and immune function, and has good safety.

R985;R979.5