de Jager P, van Altena R
Faculty of Medical Sciences, University of Groningen, The Netherlands.
Int J Tuberc Lung Dis. 2002 Jul;6(7):622-7.
To investigate the ototoxic and nephrotoxic effects of long-term use of aminoglycosides.
Patients treated for tuberculosis with aminoglycosides were evaluated for hearing loss and nephrotoxicity for a minimum of 14 days.
Hearing loss of 15 decibels (dB) at two or more frequencies, or at least 20 dB hearing loss at at least one frequency, was found in 18% of our total population treated with aminoglycosides (amikacin, kanamycin and/or streptomycin). In the group treated with kanamycin this percentage was 15.6. None of the factors sex, age, treatment duration, total aminoglycoside doses or first serum creatinine concentration, was found to be associated with hearing loss. Nephrotoxicity percentages at the end of treatment with aminoglycoside or kanamycin are 7.5% (1.9%) and 4.5% (2.3%) respectively, using the definition increase of serum creatinine > or = 27 micromol/l (> or = 44 micromol/l). Patients developing nephrotoxicity had a longer duration of treatment and received larger total doses.
Patients developing nephrotoxicity had a significantly longer duration of treatment with aminoglycosides, and received a larger total dose. We did not find any factor significantly associated with the development of hearing loss. In the long-term treatment of tuberculosis with aminoglycosides, ototoxicity seems to be a greater problem than nephrotoxicity.
研究长期使用氨基糖苷类药物的耳毒性和肾毒性作用。
对接受氨基糖苷类药物治疗结核病的患者进行至少14天的听力损失和肾毒性评估。
在我们使用氨基糖苷类药物（阿米卡星、卡那霉素和/或链霉素）治疗的全部患者中，18%出现了两个或更多频率听力损失15分贝（dB），或至少一个频率听力损失至少20 dB。在使用卡那霉素治疗的组中，这一百分比为15.6。未发现性别、年龄、治疗持续时间、氨基糖苷类药物总剂量或首次血清肌酐浓度等因素与听力损失有关。按照血清肌酐升高>或=27微摩尔/升（>或=44微摩尔/升）的定义，使用氨基糖苷类药物或卡那霉素治疗结束时的肾毒性百分比分别为7.5%（1.9%）和4.5%（2.3%）。出现肾毒性的患者治疗持续时间更长，接受的总剂量更大。
出现肾毒性的患者使用氨基糖苷类药物治疗的持续时间显著更长，且接受的总剂量更大。我们未发现任何与听力损失发生显著相关的因素。在使用氨基糖苷类药物长期治疗结核病时，耳毒性似乎比肾毒性问题更大。
