儿童肿瘤溶解综合征高尿酸血症的诊治进展

高尿酸血症是肿瘤溶解综合征（tumor lysis syndrome，TLS）中的一种严重合并症。尿酸作为人体嘌呤代谢的终产物，在生理条件下主要的存在形式为尿酸盐。血液中的尿酸盐几乎全部被肾小球滤过，而TLS所引起的大量尿酸堆积超过了肾小球的滤过能力，出现"高尿酸血症"。过剩的尿酸随血液到达人体的各个组织器官引起全身性疾病，患者可有恶心呕吐等症状，尿酸沉积在关节和肾脏中可产生关节疼痛及肾绞痛。若高尿酸血症引发急性尿酸盐肾病，则会出现严重的氮质血症和肾功能衰竭。既往只有别嘌呤醇可供临床医生选择用于高尿酸血症的预防，而对已经形成的高尿酸血症并无针对性的药物可以应用。近16年来由于尿酸氧化酶投入市场，临床医生对于预防与治疗TLS所致高尿酸血症的处理变得游刃有余。本文重点对高尿酸血症和尿酸氧化酶的临床应用进展做一综述。

Progress in diagnosis and treatment of hyperuricemia in children with tumor lysis syndrome

Hyperuricemia is a serious complication of tumor lysis syndrome (TLS). Uric acid is the end product of purine in the human body. Almost all of the uric acid in the blood is filtered by the glomeruli, and the accumulation of uric acid caused by TLS exceeds the capacity of glomeruli, which results in "hyperuricemia". Excessive uric acid reaches tissues and organs with blood and causes systemic disease. Patients may have symptoms such as nausea, vomiting, joint pain and renal colic. If hyperuricemia causes acute urate nephropathy, severe azotemia and renal failure will occur. In the past, only allopurinol was available for pediatricians to prevent hyperuricemia, while there was no specific drug for the established hyperuricemia. In the last 16 years, Due to the use of uric acid oxidase, pediatricians have become more proficient in the prevention and treatment of hyperuricemia caused by TLS. This review focuses on the hyperuricemia and clinical application of uric acid oxidase.