A trial of antioxidants N-acetylcysteine and procysteine in ARDS
A trial of antioxidants N-acetylcysteine and procysteine in ARDS
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DOI：
10.1378/chest.112.1.164
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发表时间：
1997-07-01
期刊：
影响因子：
9.6
通讯作者：
Steinberg, KP
中科院分区：
文献类型：
--
作者：
Bernard, GR;Wheeler, AP;Steinberg, KP
目的：测定 ARDS 患者的谷胱甘肽和半胱氨酸水平，并检查 N-乙酰半胱氨酸 (NAC) 和 L-2-氧代噻唑烷-1-甲酸（Procysteine；Clintec Technologies Inc；芝加哥 [OTZ]）治疗对这些水平以及与 ARDS 相关的常见生理异常和器官功能障碍的效果。 设计：随机、双盲、安慰剂对照、前瞻性临床试验地点：美国和加拿大 5 个临床中心的 ICU。患者：符合 ARDS 预定定义且需要机械通气的患者。干预：ARDS 的标准护理和 IV 输液，每 8 小时一次，持续 10 天，以下之一：NAC（70 毫克/千克，n = 14）、OTZ（63 毫克/千克，n = 17）或安慰剂（n = 15）。主要结果：两种抗氧化剂均有效在 10 天的治疗期间逐渐补充红细胞谷胱甘肽（NAC 和 OTZ 分别较基线值增加 47% 和 49%）。各组之间的死亡率没有差异（安慰剂，40%：NAC，36%；OTZ，35%）。然而，两个治疗组的急性肺损伤天数均减少，心脏指数也显着增加（NAC/OTZ[+]14%；安慰剂[-]6%）。结论：我们的研究结果表明，对于急性肺损伤/ARDS 患者，使用 NAC 或 OTZ 可以安全地补充谷胱甘肽。这种治疗可能会缩短急性肺损伤的持续时间，但需要更大规模的研究来证实这一点。
Objective: To determine the levels of glutathione and cysteine in patients with ARDS and examine the effect of treatment with N-acetylcysteine (NAC) and L-2-oxothiazolidine-1-carboxylate (Procysteine; Clintec Technologies Inc; Chicago [OTZ]) on these levels and on common physiologic abnomalities, and organ dysfunction associated with ARDS.Design: Randomized, double-blind, placebo-controlled, prospective clinical trial.Setting: ICUs in five clinical centers in the United States and Canada.Patients: Patients meeting a predetermined definition of ARDS anti requiring mechanical ventilation.Intervention: Standard care for ARDS and IV infusion, every 8 h for 10 days, of one of the following: NAC (70 mg/kg, n = 14), OTZ (63 mg/kg, n = 17), or placebo (n = 15).Main results: Both antioxidants effectively repleted RBC glutathione gradually over the 10-day treatment period (47% and 49% increases from baseline values for NAC and OTZ, respectively). There was no difference in mortality among groups (placebo, 40%: NAC, 36%; OTZ, 35%). However, the number of days of acute lung injury was decreased and there was also a significant increase in cardiac index in both treatment groups (NAC/OTZ[+]14%; placebo[-]6%).Conclusions: Our findings suggest that repletion of glutathione may safely be accomplished with NAC or OTZ in patients with acute lung injury/ARDS. Such treatment may shorten the duration of acute lung injury, but larger studies are needed to confirm this.