Objective To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.
Objective To investigate the clinical characteristics of patients with sever H1N1 influenza in Xinjiang region, and analyze risk factors related to patients’prognosis. Methods 63 patients with severe H1N1 influenza from September 2009 to December 2009, who came from five general hospitals and contagious disease hospitals were retrospectively studied. Data of baseline characteristics, treatment, and outcomes were collected. Results Among the 63 cases of severe H1N1 influenza patients, 46 patients survived, in which 30 cases were complicated with pneumonia( 63. 8% ) , 10 cases with MODS ( 43. 48% ) ;26 were male,20 were female; the median age was ( 28. 48 ±19. 59) years old.17 patients died, in which 11 were male, 6 were female; the median age was ( 39. 47 ±21. 23) years old. There were no significantdifferences in white blood cells, neutrophils, granulocytes, lymphocytes, Hb, platelets, CK-MB, HB, DH, UN,APTT, INR, K+ , Na+ , Cl - , PaO2 , SaO2 between the survival patients and the died patients ( P gt; 0. 05) .However there were significant differences in AST, ALT, CK, LDH, AL, CR, and pH ( P lt; 0. 05) .Conclusions Most of the patients with sever H1N1 influenza are young. The typical clinical manifestations are fever, cough, and expectoration. The patients usually are complicated with pneumonia. The patients complicated with MODS have a higher risk of death. Early administration of effective antiviral agents, low dose corticosteroids, and reasonable mechanical ventilation may improve the prognosis.
