目的评价细菌溶解产物减少慢性阻塞性肺疾病（COPD）的急性发作及其应用的临床价值。方法检索Cochrane、MEDLINE、EMBASE、CNKI、CBM，纳入细菌溶解产物用于预防COPD急性发作的随机对照研究。评价对照试验的方法学，提取试验的相关指标，对临床数据进行荟萃分析。结果纳入16个研究，共1746例稳定期COPD患者，结果显示细菌溶解产物相较于安慰剂组，可明显减少患者的年平均急性感染次数[SMD=-0.93，95%CI （-1.26~-0.60），P＜0.01]，急性感染的持续时间[SMD=-1.38,95%CI （-1.6~-1.11），P＜0.01]，平均住院时间[SMD=-9.01，95%CI （-10.24~-7.78），P＜0.01]，抗生素应用时间[SMD=-1.07，95%CI （-1.32~-0.82），P＜0.01]，提高患者的 T淋巴细胞水平[SMD=1.38，95%CI （0.64~2.13），P＜0.01]、IgG [SMD=1.46，95%CI （1.18~1.59），P=0.02]、IgM [SMD=0.26，95%CI （0.18~0.41），P=0.01]及6min步行距离[SMD=58.7，95%CI （33.5~84.1），P＜0.01]。然而，细菌溶解产物对肺功能指标并无影响。结论细菌溶解产物对COPD的急性发作的临床价值在于减少感染次数，其对COPD的肺功能并无改善。% Objective To evaluate the efficacy of bacterial lysates in prevention of acute exacerbation n patients with chronic obstructive pulmonary disease (COPD). Methods Literatures were retrieved from Medline, EMBASE, Cochrane Library, CBM, VIP, CNKI databases by computer and from relevant Chinese medical journals by hand. Trial selection, quality evaluation and information extraction were performed according to including and excluding criteria. Meta-analysis was conducted using RevMan 5.0 software. Results Sixteen clinical trials and 1 746 patients with stable stage COPD were included for analysis. The results showed that bacterial lysates decreased the frequency of acute exacerbation (SMD=-0.93, 95%CI:-1.26~-0.60, P<0.01), duration of acute episode (SMD=-1.38, 95%CI:-1.6~-1.11, P<0.01), length of hospital stay (SMD=-9.01, 95%CI:-10.24~-7.78, P<0.01) and time of antibiotics administration (SMD=-9.01, 95%CI:-10.24~-7.78, P<0.01). And the bacterial lysates also in-creased T cel counts (SMD=1.38, 95%CI:0.64,2.13, P<0.01), IgG (SMD=1.46,95%CI:1.18~1.59, P=0.02), IgM levels (SMD=0.26, 95%CI:0.18~0.41, P=0.01) and 6 min walking distance. However, the bacterial lysates had no influence on lung function. Conclu-sion Systematic review indicates that bacterial lysates can prevent the acute exacerbation of COPD, but cannot improve the lung function.
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