N-乙酰半胱氨酸在呼吸系统疾病中治疗优势的循证共识文件（NECTAR）
该共识由十名呼吸科专家及多学科起草委员会组成的工作组制定，采用改良Delphi流程，对八种呼吸系统疾病中N-乙酰半胱氨酸（NAC）的作用进行证据回顾并形成推荐，共识定义为预设陈述≥70%同意。专家认为NAC作为辅助治疗对慢阻肺、支气管扩张和囊性纤维化有明确临床效用，对结核和呼吸道感染有前景但需更多证据，对哮喘和间质性肺疾病常规使用证据不足。
要点
- NAC在慢阻肺尤其慢性支气管炎表型中作为辅助治疗，600 mg每日两次主要用于预防急性加重。
- NAC对支气管扩张和囊性纤维化是经验证的辅助治疗，可减少急性加重或改善肺功能。
- NAC对哮喘和间质性肺疾病常规使用证据不足，对结核和呼吸道感染需进一步证据。
核心结论
- NAC除黏液溶解作用外，其抗氧化、抗炎、免疫调节和抗生物膜特性在慢性呼吸系统疾病中具有显著临床效用。
- NAC是慢阻肺、支气管扩张和囊性纤维化经验证的辅助治疗，对结核和呼吸道感染有前景但需更多证据，对哮喘和间质性肺疾病疗效不确定。
研究设计与样本
- 专家工作组由十名呼吸科专家和多学科起草委员会组成，回顾了体外、机制、动物、观察性研究、随机试验、综述和荟萃分析中NAC在呼吸系统疾病中的作用数据。
- 研究并讨论了八种呼吸系统疾病：稳定期慢阻肺、慢阻肺急性加重、结核、抗结核药物性肝损伤、非囊性纤维化支气管扩张、囊性纤维化、细菌和病毒感染、间质性肺疾病和哮喘。
- 采用改良Delphi流程就NAC在每种疾病中的作用建立专家共识，共识定义为对预设陈述≥70%同意。
主要发现
- 专家同意NAC作为慢阻肺辅助治疗有用，尤其慢性支气管炎表型，600 mg每日两次主要用于预防急性加重。
- 慢阻肺急性加重期间，低剂量NAC可能有助于恢复。
- 在结核和抗结核药物性肝损伤中，NAC安全，降低氧化应激并可能限制肺损伤。
- 在非囊性纤维化支气管扩张中，NAC可能减少频繁急性加重者的急性加重。
- 在囊性纤维化中，NAC改善肺功能、黏液纤毛清除并破坏生物膜。
关键数值与推荐
- 慢阻肺：NAC 600 mg每日两次，主要用于预防急性加重。
- 慢阻肺急性加重：低剂量NAC可能有助于恢复。
- 非囊性纤维化支气管扩张：NAC可能减少频繁急性加重者的急性加重。
- 囊性纤维化：NAC改善肺功能、黏液纤毛清除并破坏生物膜。
- 共识定义：对预设陈述≥70%同意。
临床怎么用
- 可将NAC作为慢阻肺尤其慢性支气管炎表型的辅助治疗，按600 mg每日两次用于预防急性加重。
- 在非囊性纤维化支气管扩张频繁急性加重者和囊性纤维化患者中可考虑使用NAC作为辅助治疗。
- 不推荐对哮喘和间质性肺疾病患者常规使用NAC，对结核和呼吸道感染的使用需权衡证据前景。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Front Med (Lausanne). 2026 May 4;13:1810363. doi: 10.3389/fmed.2026.1810363. eCollection 2026. ABSTRACT BACKGROUND: N-acetylcysteine (NAC) is a key precursor of glutathione (GSH), the lung's principal antioxidant. First developed as a mucolytic, NAC is now recognized for broader antioxidant, anti-inflammatory, immunomodulatory, and anti-biofilm effects, prompting its use as an adjuvant in treatment of chronic respiratory conditions. This document consolidates existing evidence to this effect, and adds insights from practicing clinicians to guide about use of NAC in clinical practice. METHODS: An expert working group (EWG) comprising ten pulmonologists and a multidisciplinary drafting committee reviewed data from in vitro , mechanistic, animal and observational studies, randomized trials, reviews and meta-analyses for role of NAC in respiratory diseases. Eight respiratory conditions: stable COPD, acute exacerbations of COPD (AECOPD), tuberculosis (TB), and anti-tubercular drug-induced liver injury (AT-DILI), non-cystic fibrosis bronchiectasis, cystic fibrosis (CF), bacterial and viral infections, interstitial lung disease (ILD), and asthma were studied and discussed. A modified Delphi process was conducted to establish expert consensus on the role of NAC in each of these conditions. Consensus was defined as ≥70% agreement on predefined statements. RESULTS: Experts agreed that NAC is useful as an adjunct in COPD especially chronic bronchitis phenotypes mainly for preventing exacerbations at 600 mg twice daily. During AECOPD, low dose NAC may aid recovery. In TB and AT-DILI, NAC is safe, lowers oxidative stress and may limit lung damage. In non-CF bronchiectasis, NAC may reduce exacerbations in frequent exacerbators. In CF, NAC improves lung function, mucociliary clearance, and disrupts biofilms. NAC is useful in bacterial and viral infections but data for ILDs and asthma does not support routine use. NAC was consistently rated safe and well-tolerated. CONCLUSION: This consensus underscores the role of NAC in chronic respiratory diseases beyond its mucolytic properties and reiterates that NAC's antioxidant, anti-inflammatory, immunomodulatory and anti-biofilm properties provide significant clinical utility. It is a proven adjunctive therapy for COPD, bronchiectasis, and cystic fibrosis. While promising for TB and respiratory infections, further evidence is required. Its efficacy in asthma and ILDs remains uncertain. These findings guide clinical practice whil
引用
- 指南共识 · 慢阻肺：N-acetylcysteine: evidence based consensus document on the therapeutic advantages in respiratory diseases (NECTAR)
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。