Clinical controlled study on the adjuvant therapy of acetylcysteine in the treatment of newly diagnosed pulmonary tuberculosis
HU Xu
DUAN Huaxin
WANG Ke
WANG Wei
CAO Ying
QIAO Bo
CHEN Ying
Abstract：Objective To investigate the clinical efficacy of acetylcysteine as an adjunctive therapy in the treatment of newly diagnosed pulmonary tuberculosis.Methods A total of 215 patients with newly diagnosed pulmonary tuberculosis admitted to Henan Provincial Chest Hospital from January 2022 to June 2024 were prospectively selected as the study subjects and divided into two groups using a random number table method.The reference group(n=107)received the standard HRZE anti-tuberculosis treatment regimen(consisting of isoniazid,rifampin,pyrazinamide,and ethambutol),while the experimental group(n=108)received acetylcysteine in addition to the HRZE regimen.The sputum negative conversion rate,lesion absorp-tion and cavity condition,incidence of drug-induced liver injury(DILI),and liver function indicators were compared between the two groups.Results The sputum negative conversion rates in the observation group at 1,3,and 6 months post-treatment(60.19%(65/108),82.41%(89/108),95.37%(103/108),respectively)were significantly higher than those in the control group(42.99%(46/107),54.21%(58/107),78.50%(84/107),respectively),with statistically significant differences(χ2=6.363,19.769,13.498,all P＜0.05).At the final follow-up,the total lesion absorption rate in the observation group was 94.44%(102/108),sig-nificantly higher than that in the control group(81.31%(87/107)),and the cavity reduction rate in the observation group was 95.37%(103/108),higher than that in the control group(85.05%(91/107)),with statistically significant differences(χ2=8.725,6.500,both P＜0.05).Among 215 patients,29 cases(13.49%)developed DILI.The incidence of DILI in the observation group was 8.33%(9/108),significantly lower than 18.69%(20/107)in the control group(Log-rank test:χ2=5.282,P=0.022).The av-erage time to DILI onset was 67 days(95%CI:43.58-690.62)in the control group and 107 days(95%CI:75.17-139.06)in the observation group,with a statistically significant difference between the two groups(t=﹣2.083,P=0.047).After treatment,the levels of total bilirubin,aspartate aminotransferase,γ-glutamyl transferase,alkaline phosphatase and alanine aminotransferase in the observation group((16.94±4.23)μmol/L,(36.92±8.60)U/L,(113.24±10.63)U/L,(165.23±7.33)U/L,(30.60±6.35)U/L,respectively)were lower than those in the control group((23.40±5.32)μmol/L,(58.71±11.16)U/L,(165.32±9.65)U/L,(170.31±7.64)U/L,and(36.79±8.31)U/L,respectively),with statistically significant differences(t=9.860,16.045,37.602,4.975,6.140,all P＜0.001).Conclusion Acetylcysteine as an adjunctive therapy to the HRZE regimen for initial treatment of pulmonary tuberculosis demonstrates favorable efficacy.It not only improves the sputum negative conversion rate,promotes lesion absorp-tion,and enhances cavity reduction,but also reduces the risk of DILI by protecting hepatocyte function.This combination rep-resents a safe and effective treatment strategy.
Keywords：acetylcysteinepulmonary tuberculosisadjuvant therapyhepatocyte functionclinical controlled study
Publication Date：2025-12-25
Online Publishing Date：2026-01-07(First online date of this platform, not the publication date of the document)
Pages：5( 1507-1511 )