从解毒剂到多模式辅助治疗：N-乙酰半胱氨酸在犬和猫中的系统综述。

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中文摘要

引言： N-乙酰半胱氨酸（NAC）在小动物医学中被用作解毒剂、黏液溶解剂、硫醇供体和细胞保护性辅助治疗，但其证据基础在不同适应症之间以及犬与猫之间存在显著差异。我们系统评价了物种特异性的药代动力学、临床、实验和体外证据，以区分已确立的用途与推断性实践。
方法： 对一个包含104条记录的遗留证据库进行了重新筛选，并完成了对PubMed/MEDLINE、Europe PMC、Crossref解析的出版商记录、Google Scholar、选定的匈牙利数据库和期刊档案以及后向/前向引文的更新检索，截止日期为2026年8月1日。符合条件的报告评估了NAC在犬或猫体内，或在犬源或猫源组织、细胞或临床分离株中的应用。使用针对研究设计的工具评估偏倚风险，由于干预措施、模型、剂量和结局异质性过大而无法进行荟萃分析，因此对研究结果进行了叙述性综合。
结果： 71篇报告被纳入定性综合。最强的证据支持在猫和犬对乙酰氨基酚中毒时早期给予NAC。对照或临床直接证据还支持住院犬的氧化还原恢复、犬细小病毒性肠炎的辅助治疗、猫急性-on-慢性肾病中的短程静脉治疗以及选定的局部眼科应用。针对犬耳炎和感染性角膜炎病原体的抗菌和抗生物膜活性在体外可重复，一项小型临床研究支持多组分局部治疗用于浅表脓皮病；然而，NAC特异性效应和抗菌相互作用仍取决于制剂。实验性心肺、肾脏、肝脏和糖尿病器官保护研究产生了生物学上连贯但临床尚不成熟的信号。相反，围手术期神经保护、多柔比星心脏保护和雾化治疗猫哮喘的结果为中性或不利。传统水性NAC的药代动力学在犬中仍未明确，许多广泛引用的给药方案源自专家综合而非剂量探索试验。
讨论： 因此，NAC最好被视为一种有证据支持的解毒剂和情境依赖性辅助治疗，而非通用的抗氧化疗法。未来的研究应优先考虑犬的药代动力学、标准化制剂、具有临床意义的结局以及局部抗菌和肾脏适应症的前瞻性验证。

英文摘要

INTRODUCTION: N-acetylcysteine (NAC) is used in small-animal medicine as an antidote, mucolytic, thiol donor, and cytoprotective adjunct, yet its evidentiary basis varies markedly among indications and between dogs and cats. We systematically evaluated species-specific pharmacokinetic, clinical, experimental, and in vitro evidence to distinguish established uses from extrapolated practice.
METHODS: A 104-record legacy evidence library was re-screened, and an update search of PubMed/MEDLINE, Europe PMC, Crossref-resolved publisher records, Google Scholar, selected Hungarian databases and journal archives, and backward/forward citations was completed through 1 August 2026. Eligible reports evaluated NAC in dogs or cats in vivo, or in canine- or feline-derived tissues, cells, or clinical isolates. Risk of bias was appraised with design-specific tools, and findings were synthesized narratively because interventions, models, doses, and outcomes were too heterogeneous for meta-analysis.
RESULTS: Seventy-one reports were included in the qualitative synthesis. The strongest evidence supported early NAC administration for feline and canine acetaminophen toxicosis. Controlled or clinically direct evidence also supported redox restoration in hospitalized dogs, adjunctive treatment of canine parvoviral enteritis, short-course intravenous treatment in cats with acute-on-chronic kidney disease and selected topical ophthalmic applications. Antibacterial and antibiofilm activity against canine otitis and infectious-keratitis pathogens was reproducible in vitro, and a small clinical study supported multicomponent topical therapy for superficial pyoderma; however, NAC-specific effects and antimicrobial interactions remained formulation dependent. Experimental cardiopulmonary, renal, hepatic, and diabetic-organ-protection studies yielded biologically coherent but clinically immature signals. Conversely, perioperative neuroprotection, doxorubicin cardioprotection, and nebulized treatment of feline asthma were neutral or unfavorable. Conventional aqueous NAC pharmacokinetics remain undefined in dogs, and many widely quoted dosing schedules originate from expert synthesis rather than dose-ranging trials.
DISCUSSION: NAC is therefore best regarded as an evidence-supported antidote and a context-dependent adjunct, not a generic antioxidant therapy. Future studies should prioritize canine pharmacokinetics, standardized formulations, clinically meaningful outcomes, and prospective validation of topical antimicrobial and renal indications.