Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
Nephrol Dial Transplant. 2011 Dec;26(12):4073-8. doi: 10.1093/ndt/gfr211. Epub 2011 May 6.
Peritonitis is currently one of the leading complications of continuous ambulatory peritoneal dialysis (CAPD) treatment. Aminoglycosides and vancomycin are used in the treatment of CAPD peritonitis despite their potential risk for ototoxicity. N-acetylcysteine (NAC) is a molecule used in the treatment and prophylaxis of many diseases related to oxidative stress. The aim of this study was to examine whether ototoxicity due to antibiotics used in the treatment of CAPD peritonitis can be prevented by NAC.
Sixty patients, who first developed CAPD peritonitis attacks from February 2008 to April 2010 were included in this study. Patients were divided into two groups, those taking an additional NAC treatment (n = 30) and a control group (n = 30). Low- and high-frequency hearing function tests were performed on the two groups before treatment (baseline), at the end of the first (early follow-up) and the fourth week after the treatment (late follow-up). Total doses of vancomycin and amikacin were recorded.
There was no statistically significant difference between the groups in terms of hearing functions at the beginning. However, patients taking NAC had better hearing function test results 4 weeks after the treatment compared with those of the control group (P < 0.05). There were no statistical differences between posttreatment low-frequency hearing function tests conducted at the baseline and the first and the fourth weeks in patients taking NAC. The first and the fourth week's low-frequency hearing functions worsened when compared with the baseline low-frequency results in the control group (P < 0.001). It was found that NAC had a protective effect against ototoxicity on low-frequency (0.25-8 KHz) hearing functions. The first and the fourth week's high-frequency hearing functions improved when compared with baseline high-frequency hearing functions in patients taking NAC (P < 0.05), while they worsened. The first and fourth week's high-frequency tests worsened when compared with the baseline high-frequency tests in the control group (P < 0.001).
The present study suggests that intraperitoneal aminoglycoside and vancomycin administration in CAPD patients may cause low- and high-frequency hearing loss, and this ototoxic effect is related to the dose given. It was found that when the antioxidant NAC is administered alone, it prevents ototoxicity, associated with intraperitoneal amikacin and vancomycin in patients with CAPD peritonitis. In addition, it was revealed that NAC may also have a curative effect on impaired high-frequency hearing functions.
腹膜炎是目前持续性不卧床腹膜透析（CAPD）治疗的主要并发症之一。氨基糖苷类和万古霉素用于 CAPD 腹膜炎的治疗，尽管它们有耳毒性的潜在风险。N-乙酰半胱氨酸（NAC）是一种用于治疗和预防许多与氧化应激相关疾病的分子。本研究旨在研究 CAPD 腹膜炎治疗中使用的抗生素引起的耳毒性是否可以通过 NAC 预防。
本研究纳入了 2008 年 2 月至 2010 年 4 月首次发生 CAPD 腹膜炎发作的 60 例患者。患者分为两组，一组接受额外的 NAC 治疗（n = 30），另一组为对照组（n = 30）。在治疗前（基线）、治疗后第 1 周（早期随访）和第 4 周（晚期随访）对两组进行低频和高频听力功能测试。记录万古霉素和阿米卡星的总剂量。
治疗开始时，两组的听力功能无统计学差异。然而，与对照组相比，接受 NAC 治疗的患者在治疗后 4 周时听力功能测试结果更好（P < 0.05）。在接受 NAC 治疗的患者中，治疗后第 1 周和第 4 周的低频听力功能与基线时相比没有统计学差异。与对照组相比，低频听力功能在治疗后第 1 周和第 4 周时较基线时恶化（P < 0.001）。结果表明，NAC 对低频（0.25-8 kHz）听力功能具有耳毒性保护作用。接受 NAC 治疗的患者，第 1 周和第 4 周的高频听力功能较基线时改善（P < 0.05），而对照组高频听力功能在第 1 周和第 4 周时较基线时恶化（P < 0.001）。
本研究表明，CAPD 患者腹腔内氨基糖苷类和万古霉素的应用可能导致低频和高频听力损失，这种耳毒性与给予的剂量有关。当单独给予抗氧化剂 NAC 时，它可预防 CAPD 腹膜炎患者腹腔内应用氨基糖苷类和万古霉素引起的耳毒性。此外，研究结果还表明，NAC 可能对高频听力功能障碍也有治疗作用。
