Tseng C L, Wang P J, Tsau Y K, Lin M Y, Shen Y Z
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1992 Jul-Aug;33(4):251-6.
The activity of urinary N-acetyl-beta-glucosaminidase (NAG) was measured in random urines using the ratio (NAG index) of NAG to grams of urine creatinine in 102 epileptic children taking antiepileptic drugs (AEDs). A high urinary NAG index (2 SD or more above the mean for the age-matched control/normal subjects) was detected in 40 (39%, 40/102) epileptic children with AEDs. None of the 40 epileptic children with abnormal urinary NAG excretion had significant proteinuria. Among the 83 epileptic children under monotherapy, 29 cases (35%) had elevated urinary NAG excretion. Valproic acid presented the highest incidence of abnormal urinary NAG index (78%, 7/9 cases) within the monotherapy group, and the incidence was statistically significantly higher than that (26%, 14/55) in the carbamazepine group (p < 0.005). In the monotherapy group, no significant difference in serum levels of AEDs was found between children with normal urinary NAG excretion and those with abnormal. Nineteen epileptic children were treated with more than one AEDs. Eleven of them (58%, 11/19 cases) had a high urinary NAG index. The incidence of high urinary NAG index in the polytherapy group and that in monotherapy group was not significantly different (p > 0.05). This study suggests that AEDs may be potentially nephrotoxic and that urinary NAG may play a role in screening renal tubular injury in epileptic children under therapy of AEDs. Further investigation should be conducted to determine whether the effect of AEDs on renal tubular cells is or is not reversible.
在102名服用抗癫痫药物（AEDs）的癫痫患儿中，采用随机尿样检测尿N-乙酰-β-氨基葡萄糖苷酶（NAG）活性，并计算NAG与尿肌酐克数的比值（NAG指数）。在40名（39%，40/102）服用AEDs的癫痫患儿中检测到高尿NAG指数（比年龄匹配的对照/正常受试者的平均值高2个标准差或更多）。40名尿NAG排泄异常的癫痫患儿均无明显蛋白尿。在83名单药治疗的癫痫患儿中，29例（35%）尿NAG排泄升高。在单药治疗组中，丙戊酸的尿NAG指数异常发生率最高（78%，7/9例），且该发生率在统计学上显著高于卡马西平组（26%，14/55）（p<0.005）。在单药治疗组中，尿NAG排泄正常的患儿与异常患儿的AEDs血清水平无显著差异。19名癫痫患儿接受了一种以上的AEDs治疗。其中11名（58%，11/19例）尿NAG指数较高。联合治疗组高尿NAG指数的发生率与单药治疗组无显著差异（p>0.05）。本研究表明，AEDs可能具有潜在肾毒性，尿NAG可能在AEDs治疗的癫痫患儿肾小管损伤筛查中发挥作用。应进一步研究以确定AEDs对肾小管细胞的作用是否可逆。
