Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure.
Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure.
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DOI：
10.1007/s10620-012-2512-x
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发表时间：
2013-05
影响因子：
3.1
通讯作者：
Lee, William M.
中科院分区：
文献类型：
--
作者：
Singh, Sundeep;Hynan, Linda S.;Lee, William M.
N-乙酰半胱氨酸(NAC)可提高早期昏迷分级(I-II)、非对乙酰氨基酚诱导的急性肝功能衰竭(ALF)患者的无移植存活率。我们确定临床益处是否与肝功能的改善有关。在一项前瞻性的双盲试验中，173名没有对乙酰氨基酚过量证据的ALF患者按昏迷级别(I-II与III-IV)进行分层，随机分配接受静脉注射NAC或葡萄糖(安慰剂)72小时，得到4个患者组。使用入院时(第1天)和随后的第2-4天(第2-4天)获得的INR、ALT、胆红素、肌酐和AST进行二次分析，通过拟合纵向Logistic回归模型来预测死亡或移植或仅预测移植。治疗组和包括胆红素或丙氨酸氨基转移酶在内的模型研究天数是移植或死亡的预测因素(最大P<；0.03)。接受NAC治疗的早期昏迷患者在预测死亡或移植时，胆红素和ALT水平较其他3组(NAC 1-2组最大值为0.02，其他3组为0.02)有显著改善。治疗组、学习天数和胆红素是ALF患者移植的预测因子(最大P<；0.03)。在早期昏迷级别的非对乙酰氨基酚诱导的ALF患者中，移植或死亡或单独静脉注射NAC的风险降低反映在与肝细胞坏死和胆汁排泄相关的参数的改善上：ALT和胆红素，而不是INR、肌酐和AST。从几个重要的实验室指标来看，NAC似乎加速了肝脏的恢复。
N-acetylcysteine (NAC) improves transplant-free survival in early coma grade (I-II) patients with non-acetaminophen induced acute liver failure (ALF). We determined whether the clinical benefit was associated with improvements in hepatic function. In a prospective, double blind trial, 173 ALF patients without evidence of acetaminophen overdose were stratified by coma grade (I-II vs. III-IV) and randomly assigned to receive either intravenous NAC or dextrose (placebo) for 72 hours, resulting in 4 patient groups. INR, ALT, bilirubin, creatinine, and AST obtained on admission (day 1) and subsequent days (days 2-4) were used for secondary analysis performed by fitting longitudinal logistic regression models to predict death or transplantation or transplantation alone. Treatment group and day of study in models including bilirubin or ALT were predictors of transplantation or death (maximum p<0.03). Those patients with early coma grade who were treated with NAC showed significant improvement in bilirubin and ALT levels when compared to the other 3 groups (maximum p <0.02 for NAC 1-2 versus the 3 other treatments) when predicting death or transplantation. Treatment group, day of study, and bilirubin were predictors of transplantation (maximum p<0.03) in ALF patients. The decreased risk of transplantation or death or of transplantation alone with intravenous NAC in early coma grade patients with non-acetaminophen induced ALF was reflected in improvement in parameters related to hepatocyte necrosis and bile excretion: ALT and bilirubin, but not in INR, creatinine, or AST. Hepatic recovery appears hastened by NAC as measured by several important lab values.
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影响因子：
25.7
作者：
Chen Y;Johansson E;Yang Y;Miller ML;Shen D;Orlicky DJ;Shertzer HG;Vasiliou V;Nebert DW;Dalton TP
通讯作者：
Dalton TP
影响因子：
158.5
作者：
HARRISON, PM;WENDON, JA;WILLIAMS, R
通讯作者：
WILLIAMS, R
影响因子：
29.4
作者：
Lee, William M.;Hynan, Linda S.;Robuck, Patricia R.
通讯作者：
Robuck, Patricia R.
影响因子：
13.5
作者：
Walsh, TS;Hopton, P;Lee, A
通讯作者：
Lee, A
影响因子：
8.8
作者：
Rank, N;Michel, C;Spies, C
通讯作者：
Spies, C