N-乙酰半胱氨酸的快速卫生技术评估

Rapid Health Technology Assessment of N-Acetylcysteine

目的采用快速卫生技术评估评价N-乙酰半胱氨酸的有效性、安全性和经济性。方法系统检索PubMed,Embase,the Cochrane Library,Web of Science,CNKI,万方,维普和HTA相关的网站及数据库。由2名评价者独立地根据纳入和排除标准筛选文章,提取数据,评价文献质量并分析。结果共纳入17篇系统评价/Meta分析和3篇经济学评价。N-乙酰半胱氨酸对临床症状和急性加重频率有所改善,但对动脉血气氧分压(PaO2)、动脉血气二氧化碳分压(PaCO2)、第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)、一氧化碳弥散量(DLco)肺功能方面得出的结论不一致。结论N-乙酰半胱氨酸在治疗慢性支气管炎、慢性阻塞性肺疾病和特发性肺间质纤维化方面具有良好的有效性和安全性,可有效提高临床症状改善率和降低急性加重频率,对于肺功能的改善因药物剂量和研究观察时限的差异,暂未得出一致结论。N-乙酰半胱氨酸长期使用可减少慢性支气管炎发作人数和医疗成本,且经济性良好。

Objective To evaluate the efficacy,safety and economy of N-acetylcysteine by rapid health technology assessment.Methods Systematic retrieval of PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang Data,VIP and HTA related websites and databases was conducted. Two reviewers independently selected articles according to the inclusion and exclusion criteria,extracted data,evaluated literature quality and performed analysis. Results A total of 17 systematic/meta-analyses and 3 economic evaluations were included. N-acetylcysteine had improved the clinical symptoms and frequency of acute exacerbations,but the literatures had inconsistent conclusions on its effect on lung functions such as partial pressure of arterial oxygen( PaO2),partial pressure of arterial carbon dioxide( PaCO2),forced expiratory volume in the first second( FEV1),forced vital capacity( FVC),and diffusion lung capacity for carbon monoxide( DLCO). Conclusion N-acetylcysteine is effective and safe in the treatment of chronic bronchitis,chronic obstructive pulmonary disease and idiopathic pulmonary interstitial fibrosis,which can effectively improve the clinical symptoms and reduce the frequency of acute exacerbations. No agreement has been reached on the improvement of lung functions due to differences in drug dosage and study observation time. Long-term use of N-acetylcysteine can reduce the number of chronic bronchitis attacks and medical costs and is quite economical.