Effect Of N-acetylcysteine On Oxidative Stress,Inflammation And Image Absorption In Community Acquired Pneumonia

Introduction:Oxidative stress is considered to be part of the pathogenic mechanism for community-acquired pneumonia(CAP)and is closely linked to inflammation.Attenuation of oxidative stress would be expected to reduce pulmonary damage.Antioxidants have been found to be effective in alleviating lung injury and protecting against damage of other organs.Objective:The aim of the study was to compare the effect of adding N-acetylcysteine(NAC)to conventional treatment versus conventional treatment on oxidative stress,inflammatory factors and radiological changes in CAP patients.Methods:Eligible CAP patients at Weihai Municipal Hospital were stratified and randomly assigned to either NAC group or non-NAC group between August 2016 and March 2017.The NAC group received conventional treatment for pneumonia and NAC(1200 mg/day).The non-NAC group received conventional therapy.Malondialdehyde(MDA),superoxide dismutase(SOD),TAOC(total antioxidant capacity),TNF-? and CT images were evaluated at baseline and after treatment.Scores of cough,expectoration and sputum viscosity were also evaluated.The primary endpoint indicators were the changes in oxidative stress parameters(MDA,TAOC,SOD)and TNF-? after treatment in the NAC group compared with those in the non-NAC group.The secondary endpoint indicator was clinical symptoms improvement of cough,expectoration and viscosity of sputum,and any difference in CT scores after treatment in the NAC group compared with the non-NAC group.Results:Baseline levels of MDA,TAOC,SOD,and TNF-? were similar between the two groups before treatment.Plasma levels of MDA and TNF-? decreased more(p<0.05 MDA:p 0.004,TNF-?:p<0.001)in the NAC group than the non-NAC group,and there was a reliable increase in TAOC content(p 0.005).Viscosity of sputum was improved more significantly in the NAC group.There was no significant difference in plasma SOD activity change between the groups(p 0.368),and the NAC group did not show a greater improvement in CT image absorption.No NAC-related adverse effects were observed.Conclusion:1.Addition of NAC therapy for CAP patients more effectively reduced MDA and TNF-? and increased TAOC.Treatment with NAC may help to reduce oxidative and inflammatory damage in pneumonia patients.2.N-acetylcysteine can effectively reduce sputum viscosity,and help to improve mucus secretion during infection.3.N-acetylcysteine 600mg twice a day for 10 days fails to improve chest imaging absorption more effectively.It is suggested that the study of effect on pneumonia imaging absorption may need enlarging sample size,increasing NAC dosage(more than 1200 mg/day),and selecting the appropriate imaging observation moment.