University of Pittsburgh Medical Center, USA.
Ann Hepatol. 2013 Jan-Feb;12(1):6-10.
The purpose of this review was to evaluate the effectiveness of acetylcysteine in the treatment of acute liver failure not related to acetaminophen. A search of MEDLINE April 2003 through May 2012 using the Pub Med database was conducted using the keywords acetylcysteine and non-acetaminophen-induced acute liver failure or acetylcysteine and liver failure. All human case reports, case series, and research articles that discussed the use of acetylcysteine for non-acetaminophen induced liver failure were evaluated. A total of 263 articles were identified during this broad search with 11 articles included for review in this article; eight case reports, two retrospective trials, and one prospective, randomized, double-blind multicenter study. In conclusion, the data suggest marginal benefit of IV acetylcysteine in NAI-ALF with coma grades I-II; however, the routine use of acetylcysteine cannot be recommended. It may be considered in non-transplant centers while awaiting referral or when transplantation is not an option. Further studies are necessary to determine optimal dosing, duration, and criteria for patient selection.
本次综述的目的在于评估乙酰半胱氨酸治疗非对乙酰氨基酚所致急性肝衰竭的疗效。通过 Pub Med 数据库在 MEDLINE 中进行了 2003 年 4 月至 2012 年 5 月的检索，检索词为乙酰半胱氨酸和非对乙酰氨基酚诱导的急性肝衰竭，或乙酰半胱氨酸和肝衰竭。评估了所有讨论乙酰半胱氨酸治疗非对乙酰氨基酚诱导肝衰竭的人类病例报告、病例系列和研究文章。在这一广泛的搜索中，共确定了 263 篇文章，其中有 11 篇文章被纳入本文综述；8 篇病例报告，2 项回顾性试验和 1 项前瞻性、随机、双盲多中心研究。总之，数据表明，乙酰半胱氨酸对伴有 I-II 级昏迷的非对乙酰氨基酚性急性肝衰竭有一定疗效，但不能常规推荐使用乙酰半胱氨酸。在等待转院或移植不是选择时，可在非移植中心考虑使用。有必要开展进一步的研究来确定最佳的剂量、持续时间和患者选择标准。
