Fuenzalida Karen, Leal-Witt María Jesús, Guerrero Patricio, Hamilton Valerie, Salazar María Florencia, Peñaloza Felipe, Arias Carolina, Cornejo Verónica
Instituto de Nutrición y Tecnología de Alimentos INTA, Universidad de Chile, Santiago 7830490, Chile.
J Clin Med. 2021 Dec 13;10(24):5832. doi: 10.3390/jcm10245832.
Treatment and follow-up in Hereditary Tyrosinemia type 1 (HT-1) patients require comprehensive clinical and dietary management, which involves drug therapy with NTBC and the laboratory monitoring of parameters, including NTBC levels, succinylacetone (SA), amino acids, and various biomarkers of liver and kidney function. Good adherence to treatment and optimal adjustment of the NTBC dose, according to clinical manifestations and laboratory parameters, can prevent severe liver complications such as hepatocarcinogenesis (HCC). We analyzed several laboratory parameters for 15 HT-1 patients over one year of follow-up in a cohort that included long-term NTBC-treated patients (more than 20 years), as well as short-term patients (one year). Based on this analysis, we described the overall adherence by our cohort of 70% adherence to drug and dietary treatment. A positive correlation was found between blood and plasma NTBC concentration with a conversion factor of 2.57. Nonetheless, there was no correlation of the NTBC level with SA levels, αFP, liver biomarkers, and amino acids in paired samples analysis. By separating according to the range of the NTBC concentration, we therefore determined the mean concentration of each biochemical marker, for NTBC ranges above 15-25 μmol/L. SA in urine and αFP showed mean levels within controlled parameters in our group of patients. Future studies analyzing a longer follow-up period, as well as SA determination in the blood, are encouraged to confirm the present findings.
1型遗传性酪氨酸血症(HT-1)患者的治疗和随访需要全面的临床和饮食管理,这包括使用NTBC进行药物治疗以及对各项参数进行实验室监测,这些参数包括NTBC水平、琥珀酰丙酮(SA)、氨基酸以及各种肝肾功能生物标志物。根据临床表现和实验室参数,良好地坚持治疗并优化NTBC剂量调整,可预防严重的肝脏并发症,如肝癌发生(HCC)。我们在一个队列中对15例HT-1患者进行了为期一年的随访,分析了多个实验室参数,该队列包括长期接受NTBC治疗的患者(超过20年)以及短期患者(一年)。基于此分析,我们描述了我们队列中70%的患者对药物和饮食治疗的总体依从性。发现血液和血浆NTBC浓度之间呈正相关,转换因子为2.57。然而,在配对样本分析中,NTBC水平与SA水平、αFP、肝脏生物标志物和氨基酸之间没有相关性。因此,通过根据NTBC浓度范围进行分离,我们确定了NTBC浓度高于15 - 25μmol/L时每个生化标志物的平均浓度。在我们的患者组中,尿SA和αFP的平均水平在可控参数范围内。鼓励未来进行更长随访期分析以及血液中SA测定的研究,以证实目前的发现。