目的 系统评价大剂量布地奈德治疗慢性阻塞性肺病急性加重期（AECOPD）的疗效和安全性，为临床合理用药提供参考。方法 检索Cochrane Library、PubMed、Embase、万方数据库、中国学术期刊全文数据库（CNKI）和中国生物医学文献数据库（CBM）等专业数据库，收集大剂量布地奈德（试验组）对比常规剂量布地奈德（对照组）治疗AECOPD的随机对照试验（RCT），时间从建库到2019年5月。提取相关资料并评价文献质量，使用RevMan 5.3软件进行Meta-分析。结果 共纳入12项RCTs，878例患者。Meta-分析结果显示，试验组患者在改善临床症状评分［MD=-1.00，95% CI（-1.44，-0.56），P<0.01］、升高动脉血氧分压（PaO₂）［MD=5.71，95% CI（5.03，6.38），P<0.01］、降低动脉血二氧化碳分压（PaCO₂）［MD=-5.75，95% CI（-7.24，-4.26），P<0.01］、升高1 s用力呼气量（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］均显著优于对照组。但试验组患者口腔真菌发生率［RR=3.18，95% CI（1.18，8.55），P=0.02］也显著大于对照组。结论 大剂量布地奈德治疗AECOPD与常规剂量相比，临床疗效更优，但增加口腔真菌感染的风险。

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