Benefits of High-Dose N-Acetylcysteine to Exacerbation-Prone Patients With COPD
Benefits of High-Dose N-Acetylcysteine to Exacerbation-Prone Patients With COPD
复制标题
DOI：
10.1378/chest.13-2784
复制
发表时间：
2014-09-01
期刊：
影响因子：
9.6
通讯作者：
Tseng, Cee Zhung Steven
中科院分区：
文献类型：
--
作者：
Hoi Nam Tse;Raiteri, Luca;Tseng, Cee Zhung Steven
背景技术背景：尽管已建议使用高剂量N-乙酰半胱氨酸（NAC）减少COPD急性加重，但尚不清楚哪类COPD患者将从NAC治疗中获益最多。本研究的目的是比较高风险和低风险的中国COPD patients.METHODS的效果高剂量NAC（600 mg bid）与肺功能测定证实的稳定期COPD患者随机治疗与NAC 600 mg bid或安慰剂除了他们的常规治疗。患者每16周随访一次，共随访1年。根据当前GOLD定义的每例患者的基线加重风险进行进一步分析（Global Initiative for Chronic Obstructive Lung Disease）策略分析高风险和低风险患者中大剂量NAC的效果。（男性，93.2%;平均年龄，70.8 ± 0.74岁;使用支气管扩张剂前FEV 1，53.9 ± 2.0%;治疗组间基线特征相当），108例（NAC，52例;安慰剂，56例）完成了1年研究。对于高危患者（n = 89），与安慰剂相比，高剂量NAC显著降低了急性发作频率（8个月和12个月时分别为0.85 vs 1.59 [P = .019]和1.08 vs 2.22 [P = .04]），至首次加重的时间延长（P = .02），并增加了1年时无加重的概率（51.3% vs 24.4%，P = .013）。这种有益的效果，高剂量NAC与安慰剂是不显着的低风险patients.CONCLUSIONS：高剂量NAC（600毫克，每日两次）为1年减少急性加重和首次急性加重的时间在高风险，但不是在低风险的中国COPD患者。
BACKGROUND: Although high-dose N-acetylcysteine (NAC) has been suggested to reduce COPD exacerbations, it is unclear which category of patients with COPD would benefit most from NAC treatment. The objective of this study was to compare the effect of high-dose NAC (600 mg bid) between high-risk and low-risk Chinese patients with COPD.METHODS: Patients with spirometry-confirmed stable COPD were randomized to treatment with either NAC 600 mg bid or placebo in addition to their usual treatments. Patients were followed up every 16 weeks for a total of 1 year. Further analysis was performed according to each patient's exacerbation risk at baseline as defined by the current GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy to analyze the effect of high-dose NAC in high-risk and low-risk patients.RESULTS: Of the 120 patients with COPD randomized (men, 93.2%; mean age, 70.8 +/- 0.74 years; prebronchodilator FEV1, 53.9 +/- 2.0%; baseline characteristics comparable between treatment groups), 108 (NAC, 52; placebo, 56) completed the 1-year study. For high-risk patients (n = 89), high-dose NAC compared with placebo significantly reduced exacerbation frequency (0.85 vs 1.59 [P = .019] and 1.08 vs 2.22 [P = .04] at 8 and 12 months, respectively), prolonged time to first exacerbation (P = .02), and increased the probability of being exacerbation free at 1 year (51.3% vs 24.4%, P = .013). This beneficial effect of high-dose NAC vs placebo was not significant in low-risk patients.CONCLUSIONS: High-dose NAC (600 mg bid) for 1 year reduces exacerbations and prolongs time to first exacerbation in high-risk but not in low-risk Chinese patients with COPD.