Ring E, Eber E, Erwa W, Zach M S
Department of Pediatrics, University of Graz, Austria.
Arch Dis Child. 1998 Jun;78(6):540-3. doi: 10.1136/adc.78.6.540.
To investigate possible renal toxicity of long-term gentamicin inhalation in patients with cystic fibrosis.
Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity was measured during routine respiratory clinic visits. Outpatient records were reviewed for data on long-term gentamicin inhalation, and parents and patients were interviewed for compliance. Exclusion criteria were irregular gentamicin inhalation, urinary infection or other febrile illness, intravenous aminoglycoside treatment during the previous three months, and diabetes mellitus. Patients were assigned to three groups: group 1, current gentamicin inhalation; group 2, previous gentamicin inhalation that had been stopped at least three months ago; and group 3, never any gentamicin inhalation.
52 patients (34 girls, 18 boys), mean (SD) age 11.5 (5.7) years, entered the study. Patients currently on gentamicin inhalation (n = 20) were significantly younger and had higher urinary NAG activity (0.83 (0.57) U/mmol creatinine) than the 23 patients without gentamicin inhalation (0.26 (0.10) (p = 0.0001) and the nine patients with previous gentamicin inhalation (0.32 (0.15) (p = 0.0125). Twelve patients on current gentamicin inhalation had raised NAG values but all those in groups 2 and 3 had NAG values within the normal range. In patients currently on gentamicin inhalation, there was a positive correlation between urinary NAG activity and cumulative dose of nebulised gentamicin (r = 0.60, p = 0.0049).
Long-term gentamicin inhalation in patients with cystic fibrosis poses a risk of renal toxicity. It is not known whether further treatment might result in more severe renal damage.
研究长期吸入庆大霉素对囊性纤维化患者肾脏可能产生的毒性。
在常规呼吸门诊就诊期间测量尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）活性。查阅门诊记录以获取长期吸入庆大霉素的数据，并对家长和患者进行访谈以了解依从性。排除标准为庆大霉素吸入不规律、泌尿系统感染或其他发热性疾病、前三个月内接受过静脉氨基糖苷类治疗以及糖尿病。患者被分为三组：第1组，当前正在吸入庆大霉素；第2组，至少在三个月前已停止吸入庆大霉素；第3组，从未吸入过庆大霉素。
52例患者（34例女孩，18例男孩），平均（标准差）年龄11.5（5.7）岁，进入研究。当前正在吸入庆大霉素的患者（n = 20）比未吸入庆大霉素的23例患者（0.26（0.10）（p = 0.0001）以及之前吸入过庆大霉素的9例患者（0.32（0.15）（p = 0.0125）显著年轻且尿NAG活性更高（0.83（0.57）U/mmol肌酐）。12例当前正在吸入庆大霉素的患者NAG值升高，但第2组和第3组的所有患者NAG值均在正常范围内。在当前正在吸入庆大霉素的患者中，尿NAG活性与雾化庆大霉素的累积剂量之间存在正相关（r = 0.60，p = 0.0049）。
囊性纤维化患者长期吸入庆大霉素存在肾脏毒性风险。尚不清楚进一步治疗是否会导致更严重的肾脏损害。
