N-乙酰半胱氨酸治疗可降低2型糖尿病患者的主要不良心血管事件。

N-acetylcysteine therapy reduces major adverse cardiovascular events in patients with type 2 diabetes mellitus.

作者信息

Sun Mingyang, Lu Zhongyuan, Chen Wan-Ming, Lv Shuang, Fu Ningning, Yang Yitian, Wang Yangyang, Miao Mengrong, Wu Szu-Yuan, Zhang Jiaqiang

机构信息

Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.

Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China; Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China.

出版信息

Atherosclerosis. 2025 Mar;402:119117. doi: 10.1016/j.atherosclerosis.2025.119117. Epub 2025 Jan 31.

DOI:10.1016/j.atherosclerosis.2025.119117

PMID:39903949

Abstract

BACKGROUND

Effective preventive strategies for major adverse cardiovascular events (MACE) in T2DM patients are limited. Recent studies have explored the cardiovascular benefits of N-Acetylcysteine (NAC), an antioxidant with endothelial protective properties. This study investigates the long-term effects of NAC on MACE risk in T2DM patients, focusing on its potential as an adjunctive therapy.

METHODS

This population-based cohort study used data from Taiwan's National Health Insurance Research Database (NHIRD) and included 46,718 T2DM patients diagnosed between 2008 and 2018, with follow-up until December 31, 2021. Propensity score matching (PSM) ensured balanced comparisons between NAC users and non-users. Cox regression and time-dependent Cox hazards models assessed MACE risk, adjusting for multiple covariates.

RESULTS

In the matched cohort of 23,359 NAC users and 23,359 non-users, NAC users had a significantly lower incidence of MACE (41.74 % vs. 46.87 %, P < .0001). Adjusted Hazard Ratios (aHRs) indicated a consistent protective effect of NAC against overall MACE (aHR: 0.84; 95 % CI: 0.81-0.86, P < .0001). Higher cumulative defined daily doses (cDDD) of NAC correlated with reduced MACE risk, with the highest quartile (Q4) showing an aHR of 0.61 (95 % CI: 0.58-0.64, P < .0001).

CONCLUSION

This study underscores the significant reduction in MACE risk among T2DM patients with long-term NAC therapy. Notably, the findings emphasize NAC's dose-dependent effectiveness in diminishing MACE incidence, indicating its potential as a valuable adjunctive therapy for managing cardiovascular risk in T2DM patients.

摘要

背景

2型糖尿病（T2DM）患者主要不良心血管事件（MACE）的有效预防策略有限。最近的研究探讨了N-乙酰半胱氨酸（NAC）的心血管益处，NAC是一种具有内皮保护特性的抗氧化剂。本研究调查了NAC对T2DM患者MACE风险的长期影响，重点关注其作为辅助治疗的潜力。

方法

这项基于人群的队列研究使用了台湾国民健康保险研究数据库（NHIRD）的数据，纳入了2008年至2018年间诊断出的46718例T2DM患者，随访至2021年12月31日。倾向评分匹配（PSM）确保了NAC使用者和非使用者之间的均衡比较。Cox回归和时间依赖性Cox风险模型评估了MACE风险，并对多个协变量进行了调整。

结果

在23359名NAC使用者和23359名非使用者的匹配队列中，NAC使用者的MACE发生率显著较低（41.74%对46.87%，P <.0001）。调整后的风险比（aHRs）表明NAC对总体MACE具有一致的保护作用（aHR：0.84；95%CI：0.81-0.86，P <.0001）。NAC的累积限定日剂量（cDDD）越高，MACE风险越低，最高四分位数（Q4）的aHR为0.61（95%CI：0.58-0.64，P <.0001）。