Gibey R, Dupond J L, Alber D, Leconte des Floris R, Henry J C
Clin Chim Acta. 1981 Oct 8;116(1):25-34. doi: 10.1016/0009-8981(81)90165-0.
Concentrations of N-acetyl-beta-D-glucosaminidase (NAG), alanine-amino-peptidase (AAP) and beta-2-microglobulin (beta 2M) were determined daily in the urine of 28 patients treated with gentamicin (2-3 mg . kg-1 . day-1) for a mean of 15 days. All had normal renal function. Increased activity in NAG and AAP was observed for all patients, either immediately or after 2 or 3 days of treatment. The results were compared with serum creatinine concentrations and urinary beta 2M levels. This study indicates a relationship between the nephrotoxicity of gentamicin and initial urinary enzymic activity(NAGi) prior to any treatment. The degree of NAG response during the first ten days of treatment appeared as a second prognostic factor. Renal failure was observed for one out of the 12 patients with normal NAGi (NAGi less than 200 mumol/day). Seven of them showed a marked enzyme activity response (greater than 1500 mumol/day) with an increase in beta 2M activity. Eleven out of the 16 patients with elevated NAGi (NAGi greater than 200 mumol/day) developed renal failure and showed an elevated maximal response. The concentration of AAP appears to be of little prognostic value. The variation in individual maximal urinary enzyme responses observed among the 28 patients during the first ten days of treatment points to the existence of individual sensitivities to gentamicin, the exact mechanism of which remains unclear.
对28例接受庆大霉素（2 - 3mg·kg⁻¹·d⁻¹）治疗平均15天的患者，每日测定其尿中N - 乙酰 - β - D - 氨基葡萄糖苷酶（NAG）、丙氨酸氨基肽酶（AAP）和β₂微球蛋白（β₂M）的浓度。所有患者肾功能均正常。所有患者在治疗即刻或2至3天后均观察到NAG和AAP活性增加。将结果与血清肌酐浓度和尿β₂M水平进行比较。本研究表明庆大霉素肾毒性与任何治疗前的初始尿酶活性（NAGi）之间存在关联。治疗前10天NAG的反应程度似乎是第二个预后因素。12例NAGi正常（NAGi小于200μmol/天）的患者中有1例出现肾衰竭。其中7例显示出明显的酶活性反应（大于1500μmol/天），β₂M活性增加。16例NAGi升高（NAGi大于200μmol/天）的患者中有11例发生肾衰竭并显示出最大反应升高。AAP的浓度似乎预后价值不大。在28例患者治疗的前10天观察到的个体最大尿酶反应变化表明存在对庆大霉素的个体敏感性，其确切机制尚不清楚。
