Jeha Sima, Pui Ching-Hon
St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, Tenn., USA.
Contrib Nephrol. 2005;147:69-79. doi: 10.1159/000082545.
Spontaneous or treatment-induced tumor lysis syndrome (TLS) can cause significant morbidity and potential mortality. Vigorous hydration, alkalinization and inhibition of uric acid synthesis are the most frequently used methods for prevention of TLS. However, this approach requires hospitalization and tedious nursing care, and fails to prevent renal insufficiency in up to 25% of high-risk patients. With increased intensity and efficacy of cancer therapies, and the current trend to deliver treatment in the outpatient setting, novel approaches at management of TLS are needed. Unlike allopurinol, urate oxidase promptly reduces the existing uric acid pool, prevents accumulation of xanthine and hypoxanthine, and does not require alkalinization, facilitating phosphorus excretion. A recombinant form of urate oxidase, rasburicase, is now available. In this chapter we will present an overview of rasburicase development and discuss the impact of rasburicase in the prevention and management of TLS.
自发性或治疗诱导的肿瘤溶解综合征（TLS）可导致严重的发病率和潜在的死亡率。积极补液、碱化尿液以及抑制尿酸合成是预防TLS最常用的方法。然而，这种方法需要住院治疗和繁琐的护理，并且在高达25%的高危患者中无法预防肾功能不全。随着癌症治疗强度和疗效的提高，以及目前在门诊环境中进行治疗的趋势，需要新的TLS管理方法。与别嘌醇不同，尿酸氧化酶能迅速减少现有的尿酸池，防止黄嘌呤和次黄嘌呤的积累，并且不需要碱化尿液，有利于磷的排泄。一种重组形式的尿酸氧化酶，即拉布立酶，现已上市。在本章中，我们将概述拉布立酶的研发情况，并讨论拉布立酶在预防和管理TLS中的作用。
