The invention relates to a preparation method of hydrocortisone acetate or an analogue thereof. Hydrocortisone acetate or the analogue thereof has a structural formula represented as a formula VIII. According to the invention, a compound I is subject to an oxidation reaction, a carbonyl protection reaction, a reduction and hydrolysis reaction, a cyano substitution reaction, a silicon alkyloxy protection reaction, an intramolecular nucleophilic substitution reaction, and a substitution reaction, such that hydrocortisone acetate or the analogue thereof is prepared. The initial raw materials are easy to obtain, and the yield is high and stable. The compound I is represented by a formula I, wherein R is H or alkyl.