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浙江大学学报(医学版)  2021, Vol. 50 Issue (4): 514-523    DOI: 10.3724/zdxbyxb-2021-0255
专题报道     
遗传性酪氨酸血症Ⅰ型及其筛查和诊治进展
唐玥(),孔元原()
首都医科大学附属北京妇产医院 北京妇幼保健院新生儿疾病筛查科,北京 100020
Hereditary tyrosinemia type Ⅰ: newborn screening, diagnosis and treatment
TANG Yue(),KONG Yuanyuan()
Department of Newborn Screening, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100020, China
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摘要:

遗传性酪氨酸血症Ⅰ型(HT-1)是因延胡索酰乙酰乙酸水解酶缺陷所致的一种常染色体隐性遗传代谢病。患者体内酪氨酸分解代谢受阻,毒性代谢物蓄积,导致严重肝功能损害、肾小管功能障碍及神经危象,患肝细胞癌风险加大。本病多于婴儿期起病,未获得及时诊治者总体预后不佳。新生儿筛查可早期发现无症状患儿,以琥珀酰丙酮作为筛查指标具有较高的特异度及敏感度。依据典型生化指标改变及分子遗传学检测结果可帮助明确诊断。尼替西农联合低酪氨酸饮食治疗可显著改善患者预后,对于没有条件使用尼替西农患者,肝移植是有效的治疗手段。酶替代疗法、肝细胞移植及基因治疗仍处于临床研究阶段,有望日后为患者提供新的治疗方案。

关键词: 新生儿筛查遗传性酪氨酸血症Ⅰ型琥珀酰丙酮尼替西农肝移植综述    
Abstract:

Hereditary tyrosinemia type Ⅰ (HT-1) is a severe autosomal recessive inherited metabolic disease. Due to the deficiency of fumarylacetoacetase hydrolase (FAH), the toxic metabolites are accumulated in the body, resulting in severe liver dysfunction, renal tubular dysfunctions, neurological crises, and the increased risk of hepatocellular carcinoma. Clinical symptoms typically begin at 1?year after the birth; the prognosis of patients is poor if they are not treated timely. Succinylacetone is a specific and sensitive marker for HT-1, and the screening in newborns can make early diagnosis of HT-1 at the asymptomatic stage. The diagnosis of HT-1 can be confirmed based on the characteristic biochemical findings and molecular testing of mutations in both alleles of FAHgene. Combined treatment with nitisinone and a low tyrosine diet may significantly improve outcomes for patients. Liver transplantation is an effective treatment in cases where nitisinone is not available. Some novel HT-1 treatments are in clinical trials, including enzyme replacement therapy, hepatocyte transplantation and gene-targeted therapy.

Key words: Neonatal screening    Hereditary tyrosinemia type Ⅰ    Succinylacetone    Nitisinone    Liver transplantation    Review
收稿日期: 2021-05-07 出版日期: 2021-11-01
CLC:  R722.1  
基金资助: 国家重点研发计划(2016YFC1000304)
通讯作者: 孔元原     E-mail: tangyue@mail.ccmu.edu.cn;kongyuanyuan1971@163.com
作者简介: 唐 玥,医师,主要从事儿童遗传代谢病筛查和诊治工作;E-mail:tangyue@mail.ccmu.edu.cn;https://orcid.org/0000-0002-2906-357X
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唐玥,孔元原. 遗传性酪氨酸血症Ⅰ型及其筛查和诊治进展[J]. 浙江大学学报(医学版), 2021, 50(4): 514-523.

TANG Yue,KONG Yuanyuan. Hereditary tyrosinemia type Ⅰ: newborn screening, diagnosis and treatment. J Zhejiang Univ (Med Sci), 2021, 50(4): 514-523.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0255        http://www.zjujournals.com/med/CN/Y2021/V50/I4/514

图 1  遗传性酪氨酸血症Ⅰ型的病因及发病机制示意由苯丙氨酸合成及饮食或自身蛋白质分解生成的酪氨酸可在一系列酶的催化下最终分解代谢为延胡索酸和乙酰乙酸参与糖和脂肪酸代谢. 酪氨酸代谢途径中的终末酶延胡索酰乙酰乙酸水解酶缺陷直接导致酪氨酸的代谢产物延胡索酰乙酰乙酸分解受阻,延胡索酰乙酰乙酸及其前体物质马来酰乙酰乙酸蓄积,进而衍生为琥珀酰乙酰乙酸,并进一步代谢生成琥珀酰丙酮. 延胡索酰乙酰乙酸及琥珀酰丙酮可诱导肝细胞癌. 琥珀酰丙酮可导致肝损害及肾小管功能异常. 琥珀酰丙酮可竞争性抑制δ-氨基乙酰丙酸脱水酶活性,抑制δ-氨基-γ-酮戊酸脱水缩合生成卟胆原,导致血红素合成减少,出现急性间歇性卟啉症样改变. 延胡索酰乙酰乙酸及琥珀酰丙酮可抑制蛋氨酸S-腺苷转移酶及4-羟基苯丙酮酸双加氧酶活性,导致继发性高蛋氨酸血症,并导致酪氨酸水平进一步升高.
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