Center for Cancer and Blood Disorders, The Children's Hospital, 13123 East 16th Ave. Box B115, Aurora, CO 80045, USA.
Curr Opin Pediatr. 2010 Feb;22(1):113-6. doi: 10.1097/MOP.0b013e32833499e5.
Acute tumor lysis syndrome (TLS) is characterized by the triad of hyperuricemia, hyperkalemia, and hyperphosphatemia and is caused by the death of tumor cells and release of intracellular contents into the circulation. This syndrome is most frequently associated with hematopoietic malignancies with a high growth fraction, including acute leukemias and lymphomas, but can be encountered in patients with nonhematopoietic solid tumors. Acute tumor lysis is typically precipitated by chemotherapy leading to rapid cell death, but may also occur spontaneously prior to treatment. In severe cases, the metabolic abnormalities of TLS can cause renal failure, cardiac arrhythmias, and death. Standard therapies include intravenous hydration, alkalinization of the urine to increase the solubility of uric acid, and administration of allopurinol to block production of uric acid. Recombinant urate oxidase (rasburicase) is a newer agent that directly cleaves uric acid. It is important for the clinician to maintain a high level of clinical suspicion for TLS when initiating therapy in children newly diagnosed with cancer, including those with solid tumors, and to know how to prevent and treat this potentially deadly metabolic complication.
急性肿瘤细胞溶解综合征（TLS）的特征为三联征，即高尿酸血症、高钾血症和高磷酸血症，是由肿瘤细胞死亡和细胞内物质释放到循环中引起的。这种综合征最常与高生长分数的血液恶性肿瘤相关，包括急性白血病和淋巴瘤，但也可发生于非血液系统实体瘤患者。急性肿瘤细胞溶解通常由导致细胞快速死亡的化疗引起，但也可在治疗前自发发生。在严重的情况下，TLS 的代谢异常可导致肾衰竭、心律失常和死亡。标准治疗包括静脉补液、尿液碱化以增加尿酸的溶解度，以及使用别嘌醇阻断尿酸的生成。重组尿酸氧化酶（rasburicase）是一种新型药物，可直接裂解尿酸。当开始对新诊断为癌症的儿童（包括实体瘤患儿）进行治疗时，临床医生应高度怀疑 TLS 的发生，并了解如何预防和治疗这种潜在致命的代谢并发症。
