Abstract: Background　Viral pneumonia prevalence is relatively high recently，among which influenza virus-induced viral pneumonia has high mortality.Previous research have shown intravenous immunoglobulins is an adjuvant treatment for severe pneumonia.However，clinical efficacy of this therapy in studies（consisting of only a few articles and case reports）of severe viral pneumonia is insufficient and lack of systematic evidence to further prove it.Objective　To explore the efficacy of high-dose intravenous gamma globulin in adult patients with severe viral pneumonia by a meta-analysis.Methods　Databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，Wanfang Data，CMB and VIP were searched from inception to March 5，2020 for randomized controlled trials（RCTs）in which efficacies of routine treatment with high-dose intravenous gamma globulin were compared with routine treatment in adult patients with severe viral pneumonia.Quality evaluation and data extraction of the included RCTs were carried out.Meta-analysis was performed to evaluate the two types of therapies in terms of clinical efficacy，C-reactive protein（CRP），CD4+，CD4+/CD8+ ratio，IL-2，and incidence of treatment-emergent adverse events.Results　Nine RCTs involving 1 021 patients were included for analysis.All of them were evaluated as grade B in terms of methodological quality.Meta-analysis showed that the experimental group showed higher mean levels of clinical efficacy〔RR=1.24，95%CI（1.18，1.31）〕，CD4+〔MD=10.05，95%CI（9.19，10.90）〕，CD4+/CD8+ ratio〔MD=0.75，95%CI（0.68，0.82）〕and lower CRP〔MD=-3.64，95%CI（-4.23，-3.05）〕，IL-2〔MD=0.61，95%CI（0.45，0.77）〕，incidence of adverse reactionscompared 〔RR=0.30，95%CI（0.16，0.55）〕with the control group（P<0.000 01）.Conclusion　High-dose intravenous infusion of gamma globulin could improve the clinical outcome of severe viral pneumonia in adults.

Key words: Pneumonia, viral；Gamma globulin；Adults；Treatment outcome；Immunoglobulins；Adverse reaction；Meta analysis

摘要： 背景　近年来，病毒性肺炎患病率较高，尤其是流感所致的重症肺炎具有高死亡率，已有研究表明静脉滴注免疫球蛋白可辅助治疗重症肺炎，但是仅有散在研究及案例报道，缺乏系统的临床疗效评价。目的　评价静脉滴注大剂量丙种球蛋白（IVIG）辅助治疗成人重症病毒性肺炎的临床疗效。方法　检索PubMed、EMBase、Web of Science、The Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普网中关于两种治疗方案临床疗效对比的随机对照研究，检索时间为建库至2020-03-05。对纳入研究的文献进行质量评价和数据提取，收集患者的临床有效率、C反应蛋白（CRP）、CD4+、CD4+/CD8+、白介素2（IL-2）、不良反应发生率等指标，并进行Meta分析。结果　共纳入9篇文献，1 021例患者，文献质量等级均为B。Meta分析结果显示，试验组临床有效率〔RR=1.24，95%CI（1.18，1.31），P<0.000 01〕、CD4+水平〔MD=10.05，95%CI（9.19，10.90），P<0.000 01〕，CD4+/CD8+〔MD=0.75，95%CI（0.68，0.82），P<0.000 01〕〕高于对照组，治疗后CRP水平〔MD=-3.64，95%CI（-4.23，-3.05），P<0.000 01〕、IL-2水平〔MD=0.61，95%CI（0.45，0.77），P<0.000 01〕、不良反应发生率〔RR=0.30，95%CI（0.16，0.55），P<0.000 01〕低于对照组。结论　静脉滴注大剂量IVIG能改善成人重症病毒性肺炎的临床结局。

关键词: 肺炎, 病毒性, 丙种球蛋白, 成年人, 治疗结果, 免疫球蛋白, 不良反应, Meta分析