The efficacy of N-acetylcysteine in improving liver function: A systematic review and meta-analysis of controlled clinical trials

IF 2.4 Q3 NUTRITION & DIETETICS PharmaNutrition Pub Date : 2023-06-01 DOI:10.1016/j.phanu.2023.100343

Mahlagha Nikbaf-Shandiz , Shaghayegh Adeli , Amir Hossein Faghfouri , Fateme Khademi , Parsa Jamilian , Meysam Zarezadeh , Mehrangiz Ebrahimi-Mamaghani

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Abstract

Background

N-acetylcysteine (NAC) could improve liver function through its antioxidant and anti-inflammatory activities. We conducted a systematic review and meta-analysis of randomized clinical trials to examine whether NAC administration could lead to changes in liver function.

Methods

The search was done using appropriate keywords in PubMed-Medline, SCOPUS, Embase databases and Google Scholar up to July 2022. Random-effects model was employed to obtain the pooled estimate. Additional analyses including subgroup and sensitivity analyses were carried out.

Results

Eight eligible studies were identified. The results indicated no significant effect of NAC on aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), [(SMD= −0.03 pg/ml; 95% CI: −0.53, 0.47; P = 0.917, I² = 71.3%, P = 0.004), (SMD= −0.22 pg/ml; 95% CI: −0.63, 0.19; P = 0.288, I² = 56.9%, P = 0.040), (SMD= −0.22 pg/ml; 95% CI: −0.67, 0.23; P = 0.343, I² = 52.6%, P = 0.097), respectively], however, it significantly increased albumin (ALB) and decreased bilirubin levels [(SMD= 1.05 pg/ml; 95% CI: 0.41, 1.69; P < 0.001, I² = 87.3%, P < 0.001) and (SMD= −0.34 pg/ml; 95% CI: −0.53, −0.14; P < 0.001, I² = 0.0%, P = 0.447) respectively].

Conclusion

Although NAC might have favorable effect on ALB and bilirubin levels, larger trials assessing liver function as primary outcome are required.

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N-乙酰半胱氨酸改善肝功能的疗效：对照临床试验的系统综述和荟萃分析

背景N-乙酰半胱氨酸（NAC）具有抗氧化和抗炎作用，可改善肝功能。我们对随机临床试验进行了系统回顾和荟萃分析，以检查NAC给药是否会导致肝功能变化。方法截至2022年7月，在PubMed Medline、SCOPUS、Embase数据库和Google Scholar中使用适当的关键词进行搜索。采用随机效应模型来获得合并估计。进行了其他分析，包括亚组和敏感性分析。结果确定了8项符合条件的研究。结果表明，NAC对天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALP）、，[（SMD=−0.03 pg/ml；95%置信区间：−0.53，0.47；P=0.917，I2=71.3%，P=0.004），（SMD=−0.22 pg/ml；95%CI:−0.63，0.19；P=0.288，I2=56.9%，P=0.040），它显著增加了白蛋白（ALB）并降低了胆红素水平[（SMD=1.05 pg/ml；95%CI:0.41，1.69；P<；0.001，I2=87.3%，P<；001）和（SMD=-0.34 pg/ml；95%CI:−0.53，−0.14；P<，0.001，I2=0.0%，P=0.447）]。结论尽管NAC可能对ALB和胆红素水平有良好影响，但仍需要更大规模的试验来评估肝功能作为主要结果。

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