Hepatol Int. 2009 Dec;3(4):563-70. doi: 10.1007/s12072-009-9151-0. Epub 2009 Aug 29.
We aimed to study the role of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF).
A total of 47 adult patients were prospectively enrolled with NAI-ALF (group 1 or NAC group) and oral NAC was given. The primary outcome was reduction in mortality with the use of NAC in NAI-ALF. The secondary outcomes were to evaluate safety of NAC and to assess factors predicting mortality. We compared these results with records of NAI-ALF patients admitted in our hospital from 2000 to 2003 (n = 44) who were not given NAC (group 2 or historical controls).
The two groups were comparable for the etiology of ALF, prothrombin time (PT), alanine aminotransferase, creatinine, albumin, etc. The mean age in group 1 was 27.7 ± 11.8 years and in group 2 37.5 ± 18.8 years (P = 0.004). Bilirubin was 20.63 ± 11.03 and 14.36 ± 8.90 mg/dl in groups 1 and 2, respectively (P = 0.004). There were 8 (17%) and 1 (2.3%) pregnant ALF women with acute hepatitis E virus (HEV) infection in groups 1 and 2, respectively (P = 0.031). All patients were given supportive care, including mechanical ventilation. A total of 34 (37.36%) patients survived; 22 (47%) in group 1 (NAC group) and 12 (27%) in group 2 (controls) (P = 0.05). On multivariable regression analysis, patients not given NAC (odds ratio [OR] = 10.3, 95% confidence interval [CI] = 1.6-65.7), along with age older than 40 years (OR = 10.3, 95% CI = 2.0-52.5), PT more than 50 s (OR = 15.4, 95% CI = 3.8-62.2), patients requiring mechanical ventilation (OR = 20.1, 95% CI = 3.1-130.2), and interval between jaundice and hepatic encephalopathy (OR = 5.0, 95% CI = 1.3-19.1) were independent predictors of mortality.
The use of NAC causes reduction in NAI-ALF mortality and its use was safe.
我们旨在研究 N-乙酰半胱氨酸 (NAC) 在非乙酰氨基酚诱导的急性肝衰竭 (NAI-ALF) 中的作用。
前瞻性纳入 47 例成人 NAI-ALF 患者（第 1 组或 NAC 组）并口服 NAC。主要结局是使用 NAC 降低 NAI-ALF 死亡率。次要结局是评估 NAC 的安全性和评估预测死亡率的因素。我们将这些结果与我们医院 2000 年至 2003 年（n=44）未接受 NAC 治疗的 NAI-ALF 患者（第 2 组或历史对照）的记录进行比较。
两组 ALF 的病因、凝血酶原时间 (PT)、丙氨酸氨基转移酶、肌酐、白蛋白等均相似。第 1 组的平均年龄为 27.7±11.8 岁，第 2 组为 37.5±18.8 岁（P=0.004）。第 1 组和第 2 组的胆红素分别为 20.63±11.03 和 14.36±8.90mg/dl（P=0.004）。第 1 组和第 2 组分别有 8 名（17%）和 1 名（2.3%）妊娠急性戊型肝炎病毒（HEV）感染的 ALF 女性（P=0.031）。所有患者均接受了包括机械通气在内的支持性治疗。共有 34 名（37.36%）患者存活；第 1 组（NAC 组）22 名（47%），第 2 组（对照组）12 名（27%）（P=0.05）。多变量回归分析显示，未使用 NAC（比值比[OR] = 10.3，95%置信区间 [CI] = 1.6-65.7）、年龄大于 40 岁（OR = 10.3，95%CI = 2.0-52.5）、PT 大于 50s（OR = 15.4，95%CI = 3.8-62.2）、需要机械通气（OR = 20.1，95%CI = 3.1-130.2）和黄疸与肝性脑病之间的间隔（OR = 5.0，95%CI = 1.3-19.1）是死亡率的独立预测因素。
使用 NAC 可降低 NAI-ALF 死亡率，且使用安全。
