Abstract：
BACKGROUND: N-Acetylcysteine (NAC) is a recognized antioxidative agent that facilitates the conjugation of toxic metabolites. In recent years, NAC has been routinely used to limit ischaemia-reperfusion injury in liver transplantation. There remains, however, contradictory evidence on its effectiveness in liver resection. This meta-analysis examines the effectiveness of NAC in improving outcomes following hepatectomy.
METHODS: A comprehensive search of the MEDLINE, EMBASE, and Cochrane databases was performed to identify relevant randomized controlled trials (RCTs) published since database inception until November 2023. The outcomes of Day 1 biochemical markers (lactate, ALT, bilirubin, and INR), length of stay, transfusion rates, and morbidity were extracted. Quantitative pooling of data was based on a random-effects model. The study protocol was registered on PROSPERO (Registration no: CRD42023442429).
RESULTS: Five RCTs reporting on 388 patients undergoing hepatectomy were included in the analysis. There were no significant differences in patient demographics between groups. Post-operative lactate was lower in patients receiving NAC (WMD -0.61, 95% CI -1.19 to -0.04, I2 = 67%). There were, however, no differences in the post-operative INR (WMD -0.04, 95% CI -0.19 to 0.12, I2 = 96%) and ALT (WMD -94.94, 95% CI -228.46 to 40.38; I2 = 67%). More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.
CONCLUSIONS: The administration of NAC in liver resection did not alter important biochemical parameters suggesting any real effectiveness in reducing hepatic dysfunction. There were no improvements in the clinical outcomes of length of stay, transfusion rates, and overall morbidity.
METHODS: A comprehensive search of the MEDLINE, EMBASE, and Cochrane databases was performed to identify relevant randomized controlled trials (RCTs) published since database inception until November 2023. The outcomes of Day 1 biochemical markers (lactate, ALT, bilirubin, and INR), length of stay, transfusion rates, and morbidity were extracted. Quantitative pooling of data was based on a random-effects model. The study protocol was registered on PROSPERO (Registration no: CRD42023442429).
RESULTS: Five RCTs reporting on 388 patients undergoing hepatectomy were included in the analysis. There were no significant differences in patient demographics between groups. Post-operative lactate was lower in patients receiving NAC (WMD -0.61, 95% CI -1.19 to -0.04, I2 = 67%). There were, however, no differences in the post-operative INR (WMD -0.04, 95% CI -0.19 to 0.12, I2 = 96%) and ALT (WMD -94.94, 95% CI -228.46 to 40.38; I2 = 67%). More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.
CONCLUSIONS: The administration of NAC in liver resection did not alter important biochemical parameters suggesting any real effectiveness in reducing hepatic dysfunction. There were no improvements in the clinical outcomes of length of stay, transfusion rates, and overall morbidity.
摘要：
背景：N-乙酰半胱氨酸（NAC）是一种公认的抗氧化剂，可促进有毒代谢物的缀合。近年来,NAC已常规用于限制肝移植中的缺血再灌注损伤。仍然存在，然而,关于其在肝切除术中有效性的矛盾证据。这项荟萃分析检查了NAC在改善肝切除术后预后方面的有效性。
方法：对MEDLINE的全面搜索，EMBASE,和Cochrane数据库用于鉴定自数据库开始至2023年11月发表的相关随机对照试验(RCT).第1天生化标志物的结果(乳酸，ALT,胆红素,和INR），逗留时间,输血率，和发病率被提取。数据的定量汇集是基于随机效应模型。研究方案在PROSPERO上注册（注册编号：CRD42023442429）。
结果：分析中纳入了388例接受肝切除术患者的5个RCT报告。两组之间的患者人口统计学没有显着差异。接受NAC的患者术后乳酸较低（WMD-0.61，95％CI-1.19至-0.04，I2=67％）。有,然而,术后INR(WMD-0.04,95%CI-0.19至0.12,I2=96%)和ALT(WMD-94.94,95%CI-228.46至40.38;I2=67%)无差异。更重要的是,住院时间没有统计学上的显着差异，输血率，两组之间的发病率。
结论：在肝切除术中使用NAC并没有改变重要的生化指标，表明在减少肝功能障碍方面有任何真正的效果。住院时间的临床结果没有改善，输血率，和总体发病率。
方法：对MEDLINE的全面搜索，EMBASE,和Cochrane数据库用于鉴定自数据库开始至2023年11月发表的相关随机对照试验(RCT).第1天生化标志物的结果(乳酸，ALT,胆红素,和INR），逗留时间,输血率，和发病率被提取。数据的定量汇集是基于随机效应模型。研究方案在PROSPERO上注册（注册编号：CRD42023442429）。
结果：分析中纳入了388例接受肝切除术患者的5个RCT报告。两组之间的患者人口统计学没有显着差异。接受NAC的患者术后乳酸较低（WMD-0.61，95％CI-1.19至-0.04，I2=67％）。有,然而,术后INR(WMD-0.04,95%CI-0.19至0.12,I2=96%)和ALT(WMD-94.94,95%CI-228.46至40.38;I2=67%)无差异。更重要的是,住院时间没有统计学上的显着差异，输血率，两组之间的发病率。
结论：在肝切除术中使用NAC并没有改变重要的生化指标，表明在减少肝功能障碍方面有任何真正的效果。住院时间的临床结果没有改善，输血率，和总体发病率。
