Pharmacy Department, Clara Maass Medical Center, Belleville, NJ, USA.
Medicine Department, Clara Maass Medical Center, Belleville, NJ, USA.
J Pharm Pract. 2023 Aug;36(4):1008-1014. doi: 10.1177/08971900221080283. Epub 2022 Mar 24.
A novel coronavirus, severe acute respiratory syndrome coronavirus-2, was isolated from patients' lower respiratory tracts in December 2019. As of May 19, 2021, there were over 33 million reported infections and almost 600,000 deaths in the United States. The infection, coronavirus disease-19 (COVID-19), can lead to cytokine storm, with elevations in interleukin-6 (IL-6), IL-10, tumor necrosis factor-α, nuclear factor-kappaB (NF-kappaB), and glutathione reductase. NF-kappaB activation is necessary for further transcription of other pro-inflammatory markers. Glutathione may play a role in modulation of NF-kappaB activation and elevated glutathione reductase may indicate glutathione depletion. Administration of N-acetylcysteine (NAC) may replenish spent glutathione and attenuate over-activation of NF-kappaB. This retrospective case series included 10 patients who were COVID-19 positive and received intravenous NAC in an attempt to attenuate the cytokine storm. Patients' outcomes were graded based on the World Health Organization symptom severity scale from 0, no evidence of infection, to 8, death. Overall, the median WHO Scale prior to NAC was 6.5, and increased by day seven, which indicated clinical worsening. This retrospective case series showed no benefit of NAC; however, further studies are needed to elucidate if differences in drug regimens would lead to positive results.
一种新型冠状病毒，严重急性呼吸系统综合症冠状病毒 2 型，于 2019 年 12 月从患者的下呼吸道中分离出来。截至 2021 年 5 月 19 日，美国报告的感染病例超过 3300 万例，死亡病例近 60 万。这种感染，即新型冠状病毒病 19（COVID-19），可能导致细胞因子风暴，白细胞介素-6（IL-6）、IL-10、肿瘤坏死因子-α、核因子-kappaB（NF-kappaB）和谷胱甘肽还原酶水平升高。NF-kappaB 的激活对于其他促炎标志物的进一步转录是必要的。谷胱甘肽可能在调节 NF-kappaB 激活中发挥作用，而升高的谷胱甘肽还原酶可能表明谷胱甘肽耗竭。给予 N-乙酰半胱氨酸（NAC）可能会补充消耗的谷胱甘肽并减轻 NF-kappaB 的过度激活。这项回顾性病例系列研究包括 10 名 COVID-19 阳性患者，他们接受了静脉注射 NAC，试图减轻细胞因子风暴。根据世界卫生组织（WHO）症状严重程度量表，将患者的预后分为 0 级（无感染证据）至 8 级（死亡）。总体而言，NAC 治疗前的 WHO 量表中位数为 6.5，第 7 天增加，这表明临床恶化。这项回顾性病例系列研究表明 NAC 没有益处；然而，需要进一步的研究来阐明不同的药物方案是否会带来积极的结果。
