Khan Zarghuna, Naeem Muhammad O, Amin Dr Anam, Amin Laraib, Shah Abdullah, Khaliq Saad Ul, Azhar Aima, Naz Sana, Shujauddin Syed M, Arshad Muhammad A, Ali Sarosh J, Sajid Emad U, Jawad Sayed
Department of Medicine, Rehman Medical Institute.
Department of Pathology, Northwest School of Medicine.
Ann Med Surg (Lond). 2024 Aug 30;86(10):6091-6096. doi: 10.1097/MS9.0000000000002450. eCollection 2024 Oct.
The clinical effectiveness of hypertonic saline (HS) in individuals with cystic fibrosis (CF) can be compromised by adverse effects. The objective of this study was to examine the efficacy of hyaluronic acid (HA) in mitigating these negative occurrences.
A comprehensive review of the literature was carried out using three electronic databases: Medline, Cochrane Central, and Embase. This systematic review and meta-analysis investigate the efficacy of hypertonic saline (HS) with and without hyaluronic acid (HA) in treating cystic fibrosis. Primary outcomes include the incidence of cough, throat irritation, unpleasant taste, and changes in FEV1. Our findings suggest that adding HA to HS significantly reduces adverse effects and enhances patient tolerability, marking a potential improvement in cystic fibrosis therapy. Risk ratios (RRs) and mean differences (MDs) with 95% CI were used to present evaluations. The quality of RCTs was evaluated using the Cochrane Risk of Bias Tool (CRBT). The quality of the observational study was evaluated using the Newcastle-Ottawa Scale.
From the 1960 articles retrieved from the initial search, five relevant studies (=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28-0.72, =0.001), throat irritation (RR: 0.43; 95% CI, 0.22-0.81, =0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23-0.80, =0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79--2.15, =0.52), compared to patients only on HS. Patients on HA + HS had significantly lower rates of cough (RR: 0.45; 95% CI, 0.28-0.72, =0.001), throat irritation (RR: 0.43; 95% CI, 0.22-0.81, =0.009), and bad smell (RR: 0.43; 95% CI, 0.23-0.80, =0.09) when compared to patients on HS alone. Furthermore, compared to patients solely on HS, patients with HS plus HA exhibited a substantially lower forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79 to -2.15, =0.52) as well.
For CF patients who need ongoing HS therapy and have a history of poor therapy tolerance, adding HA is beneficial.
高渗盐水（HS）对囊性纤维化（CF）患者的临床疗效可能会受到不良反应的影响。本研究的目的是探讨透明质酸（HA）减轻这些负面情况的疗效。
使用三个电子数据库（Medline、Cochrane Central和Embase）对文献进行全面检索。本系统评价和荟萃分析研究了含或不含透明质酸（HA）的高渗盐水（HS）治疗囊性纤维化的疗效。主要结局包括咳嗽、咽喉刺激、味觉不适的发生率以及第一秒用力呼气容积（FEV1）的变化。我们的研究结果表明，在HS中添加HA可显著降低不良反应并提高患者耐受性，这标志着囊性纤维化治疗可能有所改善。采用风险比（RRs）和95%置信区间的均值差（MDs）进行评估。使用Cochrane偏倚风险工具（CRBT）评估随机对照试验（RCTs）的质量。使用纽卡斯尔-渥太华量表评估观察性研究的质量。
在初步检索中检索到的1960篇文章中，最终分析纳入了五项相关研究（共236例患者）。与仅接受HS治疗的患者相比，接受HS加HA治疗的患者咳嗽（RR：0.45；95%CI，0.28 - 0.72，P = 0.001）、咽喉刺激（RR：0.43；95%CI，0.22 - 0.81，P = 0.009）和异味（RR：0.43；95%CI，0.23 - 0.80，P = 0.009）的发生率显著降低。此外，与仅接受HS治疗的患者相比，接受HS加HA治疗的患者第一秒用力呼气容积（FEV1）显著降低（MD：-2.97；95%CI，-3.79 - -2.15，P = 0.52）。与仅接受HS治疗的患者相比，接受HA + HS治疗的患者咳嗽（RR：0.45；95%CI，0.28 - 0.72，P = 0.001）、咽喉刺激（RR：0.43；95%CI，0.22 - 0.81，P = 0.009）和异味（RR：0.43；95%CI，0.23 - 0.80，P = 0.009）的发生率也显著较低。此外，与仅接受HS治疗的患者相比，接受HS加HA治疗的患者第一秒用力呼气容积（FEV1）也显著降低（MD：-2.97；95%CI，-3.79至-2.15，P = 0.52）。
对于需要持续进行HS治疗且既往治疗耐受性差的CF患者，添加HA是有益的。
