N-乙酰半胱氨酸对慢性阻塞性肺疾病稳定期作用的Meta分析

目的系统评价N-乙酰半胱氨酸(NAC)治疗慢性阻塞性肺疾病(COPD)的疗效。方法计算机检索PubMed、CHEST、CNKI、CBM、VIP、万方等数据库(1995.1～2010.9),查找NAC+常规治疗与常规治疗比较治疗稳定期COPD患者疗效的随机对照试验。按纳入排除标准筛选文献、提取资料和进行方法学质量评价后,采用RevMan 5.0软件进行Meta分析。结果共纳入7个RCT,共计404例患者。Meta分析结果显示:①短期应用NAC能改善患者PaO2值[SMD=0.05 mmHg,95%CI(–0.23,0.32)]、PaCO2值[SMD=–0.29 mmHg,95%CI(–0.76,0.17)],但与对照组比较,差异无统计学意义。②NAC能显著改善患者FEV1值[SMD=1.11 L,95%CI(0.69,1.50)]、临床症状[RR=17.32,95%CI(7.11,42.18)]并降低COPD急性发作率[RR=0.20,95%CI(0.07,0.54)],与对照组相比,差异有统计学意义。结论 NAC短期应用于稳定期COPD患者并不能较常规治疗显著改善患者的动脉血气指标,但能显著改善患者的肺功能、临床症状,减少COPD急性发作频率。但本文纳入研究的质量较低,随机对照试验的实施过程未清楚报告,存在偏倚的中度可能性,因此对上述结论的临床应用应结合患者具体情况谨慎使用,并有赖于更多大规模高质量的随机对照试验结果证实。

Effects of N-acetylcystein on Patients with Stable COPD: A Meta-analysis

Objective To estimate the effects of N-acetylcystein(NAC) combined with conventional treatment on the patients with stable COPD.Methods Literatures published between January 1995 and September 2010 were searched in the databases including PubMed,CHEST,CNKI,CBM,VIP and WANGFANG for collecting the randomized control trials(RCTs) of NAC combined with the conventional treatment versus the conventional treatment on patients with stable COPD.The studies were screened according to the inclusive and exclusive crite...