N-乙酰半胱氨酸对慢性支气管炎临床疗效的Meta分析  

The clinical therapeutic effect of N-acetylcysteine on chronic bronchitis： a Meta-analysis

作　　者：陈博文 陈淼[1] 张鑫 徐丹[2] 张霞[1] Chen Bowen Chen Miao Zhang Xin Xu Dan Zhang Xia(Department of Critical Care Medicine Department of Anesthesia Affiliated Hospital of Zunyi Medical College, Zunyi 563000, Guizhou, China Department of Critical Care Medicine, Qingdao Women and Children＇s Hospital, Qingdao 266000, Shandong, China)

机构地区：[1]遵义医学院附属医院重症医学科二病区,贵州遵义563000 [2]遵义医学院附属医院麻醉科,贵州遵义563000 [3]青岛妇女儿童医院重症监护室,山东青岛266000

出　　处：《中国中西医结合急救杂志》2017年第5期481-487,共7页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金（8156010205）.

摘　　要：目的 观察N-乙酰半胱氨酸（NAC）对慢性支气管炎患者临床疗效的影响.方法 计算机检索数据库Cochrane图书馆数据库、美国国立医学图书馆Pubmed、荷兰医学文摘EMBase数据库、科学网、中国知网（CNKI）、中国生物学文献数据库（CBM）、万方数据库、维普数据库（VIP）,搜集从建库至2017年4月关于NAC联合常规药物（盐酸氨溴索、孟鲁司特、安慰剂）与单用常规药物（盐酸氨溴索、孟鲁司特、安慰剂）比较治疗慢性支气管炎疗效的随机对照试验（RCT）.主要结局指标有总有效率、肺功能指标〔用力肺活量（FVC）、1秒用力呼气容积（FEV1）占预计值的百分比〕;次要结局指标圣乔治医院呼吸问题调查问卷评分（SGRQ评分）.由2名研究者独立进行文献质量评价和资料获取,采用RevMan5.3软件进行Meta分析.绘制漏斗图评估文献发表偏倚情况.结果 纳入7篇中文和3篇英文RCT共1521例患者.Meta分析结果显示：NAC在提高慢性支气管炎患者的总有效率〔相对危险度（RR）=1.17,95%可信区间（95%CI）为1.10-1.25,P〈0.00001〕、FVC〔均数差（MD）=0.22,95%CI为0.02-0.42,P=0.03）、FEV1占预计值的百分比（MD=4.10,95%CI为1.02-7.18,P=0.005）和降低SGRQ评分（MD=-6.32,95%CI为-10.48- -2.17,P=0.003）方面均较对照组更显著.亚组分析显示：NAC联合盐酸氨溴索在改善总有效率（RR=1.20,95%CI为1.11-1.29,P〈0.00001）、FVC（RR=1.18,95%CI为0.99-1.41,P=0.04）和FEV1占预计值的百分比（MD=4.10,95%CI为1.02-7.18,P=0.005）方面均优对照组;NAC联合孟鲁司特在提高总有效率方面优于对照组（RR=1.12,95%CI为1.03-1.22,P=0.006）;NAC联合安慰剂在提高FVC方面优于对照组（MD=-0.01,95%CI为-0.02- -0.01,P〈0.00001）.漏斗图分析显示,纳入研究文献无发表偏倚.结论 NAC可提高慢性支气管炎治疗的总有效率,降低SGRQ评分和改善肺功能中FVC、FEV1占预计值的百分比,而对FEV1/FVC则无�Objective To observe the clinical therapeutic efficacy of N-acetylcysteine （NAC） on chronic bronchitis. Methods The data were retrieved by computer from data bases, including the data bases in Cochrane library, American National Library Pubmed, Holland Medical Digest EMBase, Web of Science, China National Knowledge Infrastructure （CNKI）, China Biology Medicine （CBM）, Wanfang and the Chinese Journal of Science and Technology （VIP）, starting from the dates of various database establishments to April 2017 for collecting the randomized controlled trials （RCTs） of using NAC combined with conventional drugs like ambroxol hydrochloride, montelukast or placebo （treatment group） and simply using the conventional drug alone as above conventional drugs （control group） for treatment of chronic bronchitis, and the therapeutic effects were compared between the two groups. The main indicators were total effective rate, lung function indexes [forced vital capacity （FVC）, percentage of forced expiratory volume in one second （FEV1） / the predictive value （FEV1%）]; the secondary indicator was St. George Hospital Respiratory Questionnaire evaluation score （the SGRQ evaluation score）. Document quality evaluation and data acquisition were carried out independently by two researchers. Meta-analysis was performed by using RevMan 5.3 software. A funnel graph was drawn to evaluate the article publication bias. Results There were 7 Chinese and 3 English RCTs, including 1521 patients in the study. The results of Meta analyses showed： NAC could elevate the overall therapeutic efficiency of patients with chronic bronchitis [relative risk （RR） = 1.17, 95% confidence interval （95%CI） was 1.10-1.25, P ＆lt; 0.00001], FVC [mean difference （MD） = 0.22, 95%CI was 0.02-0.42, P = 0.03）, FEV1% （MD = 4.10, 95%CI was 1.02-7.18, P = 0.005） and lower the SGRQ score （MD = -6.32, 95%CI was -10.48 to -2.17, P = 0.003）, showing that the therapeutic effects on these aspects in using NAC treat

关 键 词：N-乙酰半胱氨酸 慢性支气管炎 盐酸氨溴索 孟鲁司特 META分析 

分 类 号：R563[医药卫生—呼吸系统]