Novo M de L, Izumi T, Yokota K, Fukuyama Y
Department of Pediatrics, Tokyo Women's Medical College, Japan.
Brain Dev. 1993 Mar-Apr;15(2):157-60. doi: 10.1016/0387-7604(93)90055-d.
In an effort to detect active renal tubular dysfunction in 74 epileptic patients being treated with antiepileptic drugs (AEDs), we measured the urinary activity of two lysosomal enzymes, N-acetyl-beta-glucosaminidase (NAG) and beta-galactosidase (beta-gal). The heterogeneity of the types of seizures and therapeutic regimens permitted us to examine the potential differences in AED effects. We also examined the chronological changes in the urinary excretion rates of NAG and beta-gal in 132 healthy controls, aged 3 months to 37 years. Increased NAG excretion rates (defined as > or = 2 S.D. compared with age-matched controls) were found in 36.5% of the patients. Valproic acid was highly associated with this increase, and in combination with potassium bromide caused the highest levels of NAG excretion. Among the patients taking carbamazepine, only 11.1% exhibited high levels of NAG in urine. Children under 1 year of age showed higher levels of NAG excretion than older patients. In spite of the abnormally high urinary excretion of NAG, we could not detect any signs of renal dysfunction by urinalysis and measurement of blood urea nitrogen and serum electrolytes. We cannot exclude the possibility that the increased levels of urinary NAG in epileptic patients might be due to renal tubular enzyme induction by AEDs.
为了检测74例正在接受抗癫痫药物（AEDs）治疗的癫痫患者是否存在活动性肾小管功能障碍，我们测定了两种溶酶体酶——N - 乙酰 - β - 氨基葡萄糖苷酶（NAG）和β - 半乳糖苷酶（β - gal）的尿活性。癫痫发作类型和治疗方案的异质性使我们能够研究AEDs作用的潜在差异。我们还检测了132名年龄在3个月至37岁之间的健康对照者尿中NAG和β - gal排泄率的时间变化。36.5%的患者NAG排泄率升高（定义为与年龄匹配的对照者相比≥2个标准差）。丙戊酸与这种升高高度相关，与溴化钾联合使用时导致NAG排泄水平最高。在服用卡马西平的患者中，只有11.1%的患者尿中NAG水平较高。1岁以下儿童的NAG排泄水平高于年龄较大的患者。尽管尿中NAG排泄异常高，但通过尿液分析以及血尿素氮和血清电解质测定，我们未检测到任何肾功能障碍的迹象。我们不能排除癫痫患者尿中NAG水平升高可能是由于AEDs诱导肾小管酶所致的可能性。
