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IF 2.8 3区医学 Q2 PHARMACOLOGY & PHARMACY

BMC Pharmacology & Toxicology Pub Date : 2025-02-04 DOI:10.1186/s40360-024-00829-4

Mohamed Tawalbeh, Rewan M Ibrahim, Taif Al-Saraireh, Lubna Khreesha, Baeth Al Rawashdeh

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引用次数: 0

摘要

目的评估经耳膜应用 N-乙酰半胱氨酸预防铂类化疗患者化疗引起的耳毒性的疗效：在PubMed、Scopus、Web of Science、Cochrane Central和ClinicalTrials.gov中搜索以下概念：（（"乙酰半胱氨酸"[Mesh]）和（（"耳毒性"[Mesh]）和（（"顺铂"[Objective：评估经鼓室应用 N-乙酰半胱氨酸预防铂类化疗患者化疗所致耳毒性的疗效。[Mesh]）：纳入：随机对照试验，排除：（1）病例报告或病例系列；（2）论文；（3）综述文章；（4）会议摘要；（5）动物研究；（6）非英语研究；（7）研究人群不包括铂类化疗患者。数据提取：纯音鼓室测量法测量的听阈变化，包括高频和低频：250、500、1000、2000、4000 和 8000 Hz。我们使用 RevMan（Review Manager）5.3 版进行了荟萃分析，并使用 GRADE 评估了证据的质量：文献检索共获得 277 篇文章。在审阅了 6 篇全文文章后，有 3 项 RCT 提供了可用于荟萃分析的数据。共有 88 项顺铂类化疗候选药物被纳入最终分析。听阈显示，接受 N-乙酰半胱氨酸治疗的耳朵与对照组耳朵（未接受 N-乙酰半胱氨酸治疗的耳朵）之间存在明显的阈值差异，尤其是在高达 8000 Hz 的高频率下（汇总效应大小为 -10.67，95% CI [-12.33, -9.02]，P）：目前的数据证明，经鼓膜给药 N-乙酰半胱氨酸可保护化疗患者的耳部，最大限度地减少顺铂诱发的耳毒性和听觉损伤的持久后果。鉴于结果强调了 Sarafraz 等人（2018 年）的研究，有必要进行更多随机对照试验，扩大样本量，并对 N-乙酰半胱氨酸浓度、研究人群和评估结果进行标准化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Intratympanic N-acetylcysteine in the prevention of cisplatin-induced ototoxicity: a systematic review and meta-analysis of randomized controlled trials.

Objective: To evaluate the efficacy of the otoprotective transtympanic application of N-acetylcysteine in preventing chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy.

Data sources: PubMed, Scopus, Web of Science, Cochrane Central, and ClinicalTrials.gov were searched for the following concepts: (("Acetylcysteine" [Mesh]) AND ("Ototoxicity" [Mesh]) AND ("Cisplatin" [Objective: To evaluate the efficacy of otoprotective transtympanic application of N-acetylcysteine in the prevention of chemotherapy-induced ototoxicity in patients subjected to platinum-based chemotherapy. [Mesh]).

Study selection: Inclusion: randomized controlled trials, Exclusion: (1) case reports or case series; (2) thesis; (3) review articles; (4) conference abstracts; (5) animal studies; (6) non-english studies; (7) studies whose population was other than patients on platinum-based chemotherapy.

Data extraction: changes in hearing thresholds measured by pure tone tympanometry, covering high and low frequencies: 250, 500, 1000, 2000, 4000, and 8000 Hz. We used RevMan (Review Manager) version 5.3 to conduct the meta-analysis and GRADE to assess the quality of the evidence.

Data synthesis: The literature search yielded 277 unique articles. After reviewing six full-text articles, three RCTs provided data available for meta-analysis. A total of 88 cisplatin-based chemotherapy candidates were included for final analysis. Hearing thresholds showed a significant threshold difference between the ear treated with N-acetylcysteine and the control ear (ear not treated with N-acetylcysteine), especially at high frequencies as high as 8000 Hz (pooled effect size - 10.67, 95% CI [-12.33, -9.02], P < 0.00001). The data favored the Nac group in all frequencies as well, at 4000 Hz (pooled effect size - 2.13, 95% CI [-3.49, -0.77], P = 0.002), at 2000 Hz (pooled effect size - 1.38, 95% CI [-2.69, -0.06], P = 0.04), at 1000 Hz (pooled effect size - 1.58, 95% CI [-2.63, -0.53], P = 0.003), at 500 Hz (pooled effect size - 1.58, 95% CI [-2.62, -0.54], P = 0.003), and at the low frequency of 250 after solving the heterogeneity (pooled effect size - 0.96, 95% CI [-2.88, 0.95], P = 0.32).

Conclusions: Current data justifies the transtympanic administration of N-acetylcysteine for otoprotection in chemotherapy patients, minimizing the enduring consequences of cisplatin-induced ototoxicity and auditory impairment. Given the results' emphasis on the Sarafraz et al. (2018) study, more randomized controlled trials are necessary with an expanded sample size and standardization of N-acetylcysteine concentration, study population, and assessed outcomes.

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来源期刊

BMC Pharmacology & Toxicology PHARMACOLOGY & PHARMACYTOXICOLOGY&nb-TOXICOLOGY

CiteScore

4.80

自引率

0.00%

发文量

审稿时长

12 weeks

期刊介绍： BMC Pharmacology and Toxicology is an open access, peer-reviewed journal that considers articles on all aspects of chemically defined therapeutic and toxic agents. The journal welcomes submissions from all fields of experimental and clinical pharmacology including clinical trials and toxicology.