摘要
目的系统评价N-乙酰半胱氨酸(NAC)治疗特发性肺纤维化(IPF)的疗效和安全性。方法计算机检索PubMed、EMbase、h e Cochrane Library(2014年第2期)、CNKI、WanFang Data和VIP数据库,检索时限均从为建库至2014年2月,同时手检相关杂志,纳入有关NAC治疗IPF的随机对照试验(RCT)。由2名研究者按纳入与排除标准独立筛选文献、提取资料并评价质量后,使用RevMan 5.1软件进行Meta分析。结果共纳入13个RCT,包括713例患者。Meta分析结果显示:NAC组临床有效率高于对照组[RR=1.34,95%CI(1.19,1.51),P<0.000?1]。治疗后NAC组肺功能情况,包括PaO2[MD=6.06,95%CI(3.79,8.32),P<0.000?01]、VC%(肺活量%)[MD=4.79,95%CI(0.35,9.24),P=0.03]、DLco(一氧化碳弥散量)(%)[MD=5.74,95%CI(2.67,8.81),P=0.000?2]也好于对照组,但两组在TLC%(肺总量%)方面差异无统计学意义[MD=5.56,95%CI(–1.73,12.86),P=0.14]。纳入研究均未报告由NAC引起的频繁或严重不良反应。结论现有证据表明,长期使用NAC可改善IPF患者的临床情况、PaO2及肺功能,且不良反应少。
Objective To systematically review the efficacy and safety of N-acetylcysteine （NAC） for patients with idiopathic pulmonary fibrosis （IPF）. Methods We electronically searched PubMed, EMbase, The Cochrane Library （Issue 2, 2014）, CNKI, WanFang Data and VIP databases from the date of establishment to February 2014 for all randomized controlled trials （RCTs） on the use of NAC in patients with IPF. Manual search in relevant journals were also performed. The data extraction and quality assessment of included RCTs were conducted by two reviewers independently. Then, meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 RCTs involving 713 patients were included. The results of meta-analysis indicated that the NAC group was better than the control group in clinical effectiveness （RR=1.34, 95%CI 1.19 to 1.51, P〈0.000 1）. After treatment, the lung function was also improved in the NAC group than in the control group in the following index： PaO 2 （MD=6.06, 95%CI 3.79 to 8.32, P〈0.000 01）, vital capacity （VC） （%） （MD=4.79, 95%CI 0.35 to 9.24, P=0.03） and diffusing capacity of carbon monoxide （Dlco） （%） （MD=5.74, 95%CI 2.67 to 8.81, P=0.000 2）. However, no significant difference was found between groups in total lung capacity （TLC） （%） （MD=5.56, 95%CI –1.73 to 12.86, P=0.14）. No serious or frequently-happened adverse effect was reported in the NAC group. Conclusion The current evidence suggests that NAC in long term use could improve clinical conditions, PaO 2 and lung function of IPF patients, with less adverse effects.
出处
《中国循证医学杂志》
CSCD
2014年第4期449-455,共7页
Chinese Journal of Evidence-based Medicine
