Zhang Qianwen, Ju Yuanrong, Ma Yan, Wang Tao
Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University.
Department of Respiratory, Weihai Municipal Hospital, Weihai.
Medicine (Baltimore). 2018 Nov;97(45):e13087. doi: 10.1097/MD.0000000000013087.
Oxidative stress is considered to be part of the pathogenic mechanism for community-acquired pneumonia (CAP) and is closely linked to inflammation. Attenuation of oxidative stress would be expected to reduce pulmonary damage. Antioxidants have been found to be effective in alleviating lung injury and protecting against damage of other organs.The aim of the study was to compare the effect of adding N-acetylcysteine (NAC) to conventional treatment versus conventional treatment on oxidative stress, inflammatory factors, and radiological changes in CAP patients.Eligible CAP patients at Weihai Municipal Hospital were stratified and randomly assigned to either NAC group or non-NAC group between August 2016 and March 2017. The NAC group received conventional treatment for pneumonia and NAC (1200 mg/d). Thenon-NAC group received conventional therapy. malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAOC), tumor necrosis factor-α (TNF-α), and computed tomography (CT) images were evaluated at baseline and after treatment. The primary endpoint indicators were the changes in oxidative stress parameters (MDA, TAOC, SOD) and TNF-α after treatment in the NAC group compared with those in the non-NAC group. The secondary endpoint indicator was any difference in CT scores after treatment in the NAC group compared with the non-NAC group.Baseline levels of MDA, TAOC, SOD, and TNF-α were similar between the 2 groups before treatment. Plasma levels of MDA and TNF-α decreased more (P < .05 MDA:p 0.004, TNF-α:p <0.001) in the NAC group than the non-NAC group, and there was a reliable increase in TAOC content (p 0.005). There was no significant difference in increased plasma SOD activity between the groups (p 0.368), and the NAC group did not show a greater improvement from CT scores. No NAC-related adverse effects were observed.Addition of NAC therapy for CAP patients reduced MDA and TNF-α and increased TAOC. Treatment with NAC may help to reduce oxidative and inflammatory damage in pneumonia patients.
氧化应激被认为是社区获得性肺炎（CAP）致病机制的一部分，且与炎症密切相关。氧化应激的减轻有望减少肺部损伤。已发现抗氧化剂可有效减轻肺损伤并预防其他器官的损伤。本研究的目的是比较在常规治疗基础上加用N-乙酰半胱氨酸（NAC）与常规治疗对CAP患者氧化应激、炎症因子及影像学变化的影响。2016年8月至2017年3月，威海市立医院符合条件的CAP患者被分层并随机分为NAC组或非NAC组。NAC组接受肺炎常规治疗及NAC（1200mg/d）治疗。非NAC组接受常规治疗。在基线及治疗后评估丙二醛（MDA）、超氧化物歧化酶（SOD）、总抗氧化能力（TAOC）、肿瘤坏死因子-α（TNF-α）及计算机断层扫描（CT）图像。主要终点指标为NAC组治疗后氧化应激参数（MDA、TAOC、SOD）及TNF-α与非NAC组相比的变化。次要终点指标为NAC组治疗后CT评分与非NAC组相比的任何差异。两组治疗前MDA、TAOC、SOD及TNF-α的基线水平相似。NAC组血浆MDA和TNF-α水平下降幅度大于非NAC组（P<0.05，MDA：p=0.004，TNF-α：p<0.001），且TAOC含量有可靠增加（p=0.005）。两组血浆SOD活性增加无显著差异（p=0.368），且NAC组CT评分改善不明显。未观察到与NAC相关的不良反应。CAP患者加用NAC治疗可降低MDA和TNF-α水平并增加TAOC。NAC治疗可能有助于减少肺炎患者的氧化和炎症损伤。
