{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:52Z","timestamp":1787721652204,"version":"build-2784847793"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the clinical efficacy, safety and mechanism of N-acetylcysteine combined with conventional antituberculosis drugs in the treatment of newly diagnosed pulmonary tuberculosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 90 newly diagnosed pulmonary tuberculosis patients were randomly assigned to a Control group (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f30), Aerosol NAC group (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f30), or Oral NAC group (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f30). The Control group received standard HRZE therapy, whereas the Aerosol NAC and Oral NAC groups received additional nebulized N-acetylcysteine (300\u202fmg twice daily) or oral N-acetylcysteine (600\u202fmg once daily), respectively. Clinical efficacy, sputum conversion, St. George\u2019s Respiratory Questionnaire (SGRQ) scores, liver function indices, oxidative stress biomarkers, inflammatory markers, and adverse events were assessed over 3\u202fmonths. Data were analyzed using one-way ANOVA, repeated-measures ANOVA, Chi-square tests, and Bonferroni-adjusted\n                      <jats:italic>post hoc<\/jats:italic>\n                      analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Treatment successful response rates were significantly higher in the Aerosol NAC group (96.67%) and Oral NAC group (93.33%) than in the Control group (70.00%) (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.05). At 3\u202fmonths, sputum conversion rates reached 93.33 and 96.67% in the Aerosol NAC and Oral NAC groups, respectively, compared with 73.33% in the Control group (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.05). Both NAC groups demonstrated significantly lower SGRQ scores, improved liver function parameters (AST, ALT, TBIL, and GGT), higher antioxidant enzyme levels (SOD and GSH-Px), lower MDA concentrations, and reduced inflammatory markers (IFN-\n                      <jats:italic>\u03b3<\/jats:italic>\n                      , PCT, and IL-4) compared with the Control group (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.05). The incidence of adverse reactions was lower in both NAC groups (10.0%) than in the Control group (40.0%) (p\u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive N-acetylcysteine, administered either by aerosol inhalation or orally, significantly improved treatment outcomes, accelerated sputum conversion, reduced oxidative stress and inflammation, protected liver function, and decreased adverse events in patients with newly diagnosed pulmonary tuberculosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1844872","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:51:36Z","timestamp":1787719896000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical efficacy, safety evaluation, and mechanism of acetylcysteine in improving first-line anti-tuberculosis treatment of newly diagnosed pulmonary TB: an open-label, randomized, single-center trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Huan","family":"Zhang","sequence":"first","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Shi","sequence":"additional","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlei","family":"Wang","sequence":"additional","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiong","family":"Xie","sequence":"additional","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyan","family":"Ma","sequence":"additional","affiliation":[{"name":"Three Tuberculosis Department, Hebei Chest Hospital","place":["Shijiazhuang City, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1016\/S0140-6736(19)30308-3","article-title":"TB","volume":"393","author":"Furin","year":"2019","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/S2213-2600(19)30418-7","article-title":"WHO global progress report on TB elimination","volume":"8","author":"Harding","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.ijtb.2020.02.005","article-title":"A systemic review on TB","volume":"67","author":"Natarajan","year":"2020","journal-title":"Indian J Tuberc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"CD012918","DOI":"10.1002\/14651858.CD012918.pub2","article-title":"Shortened treatment regimens versus the standard regimen for drug-sensitive pulmonary tuberculosis","volume":"12","author":"Grace","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.rppnen.2017.10.007","article-title":"Managing latent TB infection and TB in children","volume":"24","author":"Carvalho","year":"2018","journal-title":"Pulmonol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"729","DOI":"10.3238\/arztebl.2019.0729","article-title":"The diagnosis and treatment of TB","volume":"116","author":"Su\u00e1rez","year":"2019","journal-title":"Dtsch Arztebl Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.thorsurg.2018.09.002","article-title":"History of pulmonary TB","volume":"29","author":"Pezzella","year":"2019","journal-title":"Thorac Surg Clin"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"327","DOI":"10.5588\/ijtld.20.0939","article-title":"Human rights: finding the right balance for rifampicin-resistant TB treatment","volume":"25","author":"Van Deun","year":"2021","journal-title":"Int J Tuberc Lung Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5839","DOI":"10.7150\/thno.34480","article-title":"N-acetyl cysteine-loaded graphene oxide-collagen hybrid membrane for scarless wound healing","volume":"9","author":"Li","year":"2019","journal-title":"Theranostics"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1080\/17476348.2018.1495562","article-title":"Multifaceted activity of N-acetyl-l-cysteine in chronic obstructive pulmonary disease","volume":"12","author":"Calzetta","year":"2018","journal-title":"Expert Rev Respir Med"},{"key":"ref11","first-page":"2143","article-title":"Effects of acetylcysteine aerosol inhalation associated with bronchoscopy on inflammatory and blood gas levels in elderly patients with severe ventilator-associated pneumonia","volume":"43","author":"Li","year":"2022","journal-title":"Jilin Med"},{"key":"ref12","first-page":"473","article-title":"Efficacy of N-acetylcysteine associated with ambroxol in the treatment of acute exacerbation of senile COPD","volume":"36","author":"He","year":"2022","journal-title":"Chin School Med Staff"},{"key":"ref13","first-page":"43","article-title":"Clinical analysis of aerosol inhalation of acetylcysteine solution in the treatment of acute bronchitis","volume":"35","author":"Zhou","year":"2022","journal-title":"Contemporary JCM"},{"key":"ref14","first-page":"185","article-title":"Application progress of levofloxacin associated with first-line anti-TB drugs in the treatment of pulmonary TB","volume":"44","author":"Xia","year":"2022","journal-title":"JSMC"},{"key":"ref15","first-page":"615","article-title":"The efficacy of phthalimipiperidone associated with anti-TB drugs on anti-MTB in patients with pulmonary TB and its impact on the life quality of patients","volume":"14","author":"Bian","year":"2017","journal-title":"Anti-infective Pharm"},{"key":"ref16","first-page":"419","article-title":"Expert consensus on pathological diagnosis of TB in China","volume":"40","year":"2017","journal-title":"Tuberc Respir Dis"},{"key":"ref17","first-page":"306","article-title":"Deng National Defense. Retrospective cohort analysis of clinical characteristics and treatment of drug-resistant TB with isoniazid resistance","author":"Fu","year":"2021","journal-title":"Electron J EID"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.eimc.2017.10.015","article-title":"Pathogenesis of TB and other mycobacteriosis","volume":"36","author":"Cardona","year":"2018","journal-title":"Enferm Infecc Microbiol Clin (Engl Ed)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2002013","DOI":"10.1183\/13993003.02013-2020","article-title":"Optimising pyrazinamide for the treatment of TB","volume":"58","author":"Zhang","year":"2021","journal-title":"Eur Respir J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.2174\/1871526518666180124140840","article-title":"New insights on ethambutol targets in MTB","volume":"19","author":"Ghiraldi-Lopes","year":"2019","journal-title":"Infect Disord Drug Targets"},{"key":"ref21","first-page":"1274","article-title":"Clinical observation of N-acetylcysteine in the treatment of COPD complicated with pulmonary TB","volume":"39","author":"Liu","year":"2019","journal-title":"Chin J Integr Med"},{"key":"ref22","first-page":"473","article-title":"Effects of 14-acetylcysteine associated with salmeterol and ficasone on 15-T lymphocyte subsets, inflammatory mediators and coagulation function in patients with COPD complicated with pulmonary TB","volume":"34","author":"Ma","year":"2019","journal-title":"China J Endemiol"},{"key":"ref23","first-page":"160","article-title":"Clinical and histopathological features of drug-induced liver injury","volume":"22","author":"Liu","year":"2019","journal-title":"J Pract Hepatol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.ijtb.2022.05.012","article-title":"A study to evaluate the hepatoprotective effect of N-acetylcysteine on anti tuberculosis drug induced hepatotoxicity and quality of life","volume":"70","author":"Sukumaran","year":"2023","journal-title":"Ind J Tubercul"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"19880","DOI":"10.1038\/s41598-023-46565-3","article-title":"Systematic review and network meta-analysis of efficacy and safety of interventions for preventing anti-tuberculosis drug induced liver injury","volume":"13","author":"Akkahadsee","year":"2023","journal-title":"Sci Rep"},{"key":"ref26","first-page":"728","article-title":"Analysis of related indexes of N-acetylcysteine associated with anti tuberculosis drugs in patients with chronic obstructive pulmonary disease complicated with pulmonary TB","volume":"41","author":"Tao","year":"2021","journal-title":"Chin J Hosp Pharm"},{"key":"ref27","first-page":"67","article-title":"Therapeutic effect of Butong ointment associated with salmeterol on chronic bronchial asthma and its effect on IL-4 and IFN-\u03b3","volume":"15","author":"Shi","year":"2018","journal-title":"Explorat Ration Drug Use China"},{"key":"ref28","first-page":"709","article-title":"Guidelines for primary diagnosis and treatment of pulmonary TB (2018)","volume":"18","year":"2019","journal-title":"Chin Gen Pract"},{"key":"ref29","first-page":"1052","article-title":"The value of St. George's respiratory questionnaire in evaluating the life quality of patients with chronic obstructive pulmonary disease","volume":"35","author":"Chen","year":"2014","journal-title":"Anhui Med"},{"key":"ref30","first-page":"127","article-title":"Rules for bacteriological examination of TB diagnosis","volume":"18","year":"1996","journal-title":"Chin J Tuberc Prev"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.thorsurg.2018.09.004","article-title":"Current medical management of pulmonary tuberculosis","volume":"29","author":"Belknap","year":"2019","journal-title":"Thorac Surg Clin."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1844872\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:51:49Z","timestamp":1787719909000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1844872\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":31,"alternative-id":["10.3389\/fmed.2026.1844872"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1844872","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1844872"}}