The clinical therapeutic effect of N-acetylcysteine on chronic bronchitis: a Meta-analysis
10.3969/j.issn.1008-9691.2017.05.009
- VernacularTitle:N-乙酰半胱氨酸对慢性支气管炎临床疗效的Meta分析
- Author:
Bowen CHEN
1
;
Miao CHEN
;
Xin ZHANG
;
Dan XU
;
Xia ZHANG
Author Information
1. 遵义医学院附属医院重症医学科二病区
- Keywords:
N-acetylcysteine;
Chronic bronchitis;
Ambroxol hydrochloride;
Montelukast;
Meta-analysis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2017;24(5):481-487
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the clinical therapeutic efficacy of N-acetylcysteine (NAC) on chronic bronchitis. Methods The data were retrieved by computer from data bases, including the data bases in Cochrane library, American National Library Pubmed, Holland Medical Digest EMBase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang and the Chinese Journal of Science and Technology (VIP), starting from the dates of various database establishments to April 2017 for collecting the randomized controlled trials (RCTs) of using NAC combined with conventional drugs like ambroxol hydrochloride, montelukast or placebo (treatment group) and simply using the conventional drug alone as above conventional drugs (control group) for treatment of chronic bronchitis, and the therapeutic effects were compared between the two groups. The main indicators were total effective rate, lung function indexes [forced vital capacity (FVC), percentage of forced expiratory volume in one second (FEV1) / the predictive value (FEV1%)]; the secondary indicator was St. George Hospital Respiratory Questionnaire evaluation score (the SGRQ evaluation score). Document quality evaluation and data acquisition were carried out independently by two researchers. Meta-analysis was performed by using RevMan 5.3 software. A funnel graph was drawn to evaluate the article publication bias. Results There were 7 Chinese and 3 English RCTs, including 1521 patients in the study. The results of Meta analyses showed: NAC could elevate the overall therapeutic efficiency of patients with chronic bronchitis [relative risk (RR) = 1.17, 95% confidence interval (95%CI) was 1.10-1.25, P < 0.00001], FVC [mean difference (MD) = 0.22, 95%CI was 0.02-0.42, P = 0.03), FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005) and lower the SGRQ score (MD = -6.32, 95%CI was -10.48 to -2.17, P = 0.003), showing that the therapeutic effects on these aspects in using NAC treatment group were more prominent than those in the control group. The subgroup analyses showed that NAC combined with ambroxol hydrochloride could elevate overall therapeutic efficiency (RR = 1.20, 95%CI was 1.11-1.29, P <0.00001), FVC (RR = 1.18, 95%CI was 0.99-1.41, P = 0.04) and FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005), showing that the therapeutic effects on these aspects in using NAC combined with ambroxol hydrochloride group were more prominent than those in the control group; the total rate of therapeutic effect of NAC combined with montelukast was superior to that of the control group (RR = 1.12, 95%CI =1.03-1.22, P = 0.006); NAC combined with placebo in elevating FVC aspect was better than the control group (MD =-0.01, 95%CI = -0.02 to -0.01, P < 0.00001); funnel plots showed that no publication bias was found in the literatures in the study. Conclusion It is shown that NAC for treatment of chronic bronchitis can improve the overall therapeutic efficiency, lower the SGRQ evaluation score and elevate the lung function in FVC and FEV1% aspects, but no effect on FEV1/FVC.
