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英文药名：ALDURAZYME(laronidase) 中文药名：α-艾杜糖醛酸酶注射液 生产厂家：美国健赞公司
ALDURAZYME must not be administered with other medicinal products in the same infusion. The compatibility of ALDURAZYME in solution with other products has not been evaluated. 3 DOSAGE FORMS AND STRENGTHS ALDURAZYME is supplied as a sterile solution in 5 mL vials (2.9 mg per 5 mL). 4 CONTRAINDICATIONS None. 5 WARNINGS AND PRECAUTIONS 5.1 Anaphylaxis and Allergic Reactions [see Boxed Warning ] Anaphylaxis and severe allergic reactions have been observed in patients during or up to 3 hours after ALDURAZYME infusions. Some of these reactions were life-threatening and included respiratory failure, respiratory distress, stridor, tachypnea, bronchospasm, obstructive airways disorder, hypoxia, hypotension, bradycardia, and urticaria. If anaphylactic or other severe allergic reactions occur, immediately discontinue the infusion of ALDURAZYME and initiate appropriate medical treatment. Caution should be exercised if epinephrine is being considered for use in patients with MPS I due to the increased prevalence of coronary artery disease in these patients. Interventions have included resuscitation, mechanical ventilatory support, emergency tracheotomy, hospitalization, and treatment with inhaled beta-adrenergic agonists, epinephrine, and IV corticosteroids [see Adverse Reactions (6)]. In clinical studies and postmarketing safety experience with ALDURAZYME, approximately 1% of patients experienced severe or serious allergic reactions. In patients with MPS I, pre-existing upper airway obstruction may have contributed to the severity of some reactions. Due to the potential for severe allergic reactions, appropriate medical support should be readily available when Aldurazyme is administered. Because of the potential for recurrent reactions, some patients who experience initial severe reactions may require prolonged observation. The risks and benefits of re-administering ALDURAZYME following an anaphylactic or severe allergic reaction should be considered. Extreme care should be exercised, with appropriate resuscitation measures available, if the decision is made to re-administer the product. 5.2 Acute Respiratory Complications Associated with Administration Patients with an acute febrile or respiratory illness at the time of ALDURAZYME infusion may be at greater risk for infusion reactions. Careful consideration should be given to the patient’s clinical status prior to administration of ALDURAZYME and consider delaying ALDURAZYME infusion. One patient with acute bronchitis and hypoxia experienced increased tachypnea during the first Aldurazyme infusion that resolved without intervention. The patient’s respiratory symptoms returned within 30 minutes of completing the infusion and responded to bronchodilator therapy. Approximately 6 hours after the infusion, the patient experienced coughing, then respiratory arrest, and died. Sleep apnea is common in MPS I patients. Evaluation of airway patency should be considered prior to initiation of treatment with ALDURAZYME. Patients using supplemental oxygen or continuous positive airway pressure (CPAP) during sleep should have these treatments readily available during infusion in the event of an infusion reaction, or extreme drowsiness/sleep induced by antihistamine use. 5.3 Risk of Acute Cardiorespiratory Failure Caution should be exercised when administering ALDURAZYME to patients susceptible to fluid overload, or patients with acute underlying respiratory illness or compromised cardiac and/or respiratory function for whom fluid restriction is indicated. These patients may be at risk of serious exacerbation of their cardiac or respiratory status during infusions. Appropriate medical support and monitoring measures should be readily available during ALDURAZYME infusion, and some patients may require prolonged observation times that should be based on the individual needs of the patient [see Adverse Reactions (6.3)]. 5.4 Infusion Reactions Because of the potential for infusion reactions, patients should receive antipyretics and/or antihistamines prior to infusion. If an infusion reaction occurs, regardless of pre-treatment, decreasing the infusion rate, temporarily stopping the infusion, or administering additional antipyretics and/or antihistamines may ameliorate the symptoms [see Adverse Reactions (6)]. 6 ADVERSE REACTIONS 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The most serious adverse reactions reported with ALDURAZYME treatment during clinical trials were anaphylactic and allergic reactions. Most adverse reactions reported in clinical trials were considered disease-related and unrelated to study drug. The most common adverse reactions were infusion reactions. The frequency of infusion reactions decreased over time with continued use of ALDURAZYME, and the majority of reactions were classified as being mild to moderate in severity. Most infusion reactions requiring intervention were ameliorated with slowing of the infusion rate, temporarily stopping the infusion, with or without administering additional treatments including antihistamines, antipyretics, or both. Clinical Trials in Patients 6 Years and Older A 26-week, double-blind, placebo-controlled clinical study (Study 1) of ALDURAZYME was conducted in 45 patients with MPS I, ages 6 to 43 years old, gender evenly distributed (N=23 females and 22 males). Of these 45 patients, 1 was clinically assessed as having Hurler form, 37 Hurler-Scheie, and 7 Scheie. Patients were randomized to receive either 0.58 mg/kg IV of ALDURAZYME per week for 26 weeks or placebo. All patients were treated with antipyretics and antihistamines prior to the infusions. Infusion reactions were reported in 32% (7 of 22) of ALDURAZYME-treated patients. The most commonly reported infusion reactions regardless of treatment group were flushing, pyrexia, headache, and rash. Flushing occurred in 5 patients (23%) receiving ALDURAZYME; the other reactions were less frequent. Less common infusion reactions included angioedema (including face edema), hypotension, paresthesia, feeling hot, hyperhidrosis, tachycardia, vomiting, back pain, and cough. Other reported adverse reactions included bronchospasm, dyspnea, urticaria and pruritus. Table 3 enumerates adverse reactions and selected laboratory abnormalities that occurred during the placebo-controlled study (Study 1) that were reported in at least 2 patients more in the ALDURAZYME group than in the placebo group. Table 3: Summary of Adverse Reactions that Occurred in 2 Patients More in the ALDURAZYME® Group than in the Placebo Group in the 26-Week Placebo-controlled Study (Study 1)
Clinical Trials in Patients 6 Years and Younger Study 3 was a 52-week, open-label, uncontrolled study of 20 MPS I patients, ages 6 months to 5 years old (at enrollment). Sixteen patients were clinically assessed as having the Hurler form, and 4 had the Hurler-Scheie form. All 20 patients received ALDURAZYME at 0.58 mg/kg of body weight once weekly for 26 weeks and up to 52 weeks. All patients were treated with antipyretics and antihistamines prior to the infusions. The most commonly reported serious adverse events (regardless of relationship) reported with ALDURAZYME infusions in Study 3 were otitis media (20%), and central venous catheterization required for ALDURAZYME infusion (15%). The nature and severity of infusion reactions were similar between the older and less severely affected patients in Studies 1 and 2, and the younger, more severely affected patients in Study 3. The most commonly reported adverse reactions in Study 3 were infusion reactions reported in 35% (7 of 20) of patients and included pyrexia (30%), chills (20%), blood pressure increased (10%), tachycardia (10%), and oxygen saturation decreased (10%). Other commonly reported infusion reactions occurring in ≥ 5% of patients were pallor, tremor, respiratory distress, wheezing, crepitations (pulmonary), pruritis, and rash. 6.2 Immunogenicity In clinical trials, 99 of 102 patients (97%) treated with ALDURAZYME were positive for IgG antibodies to ALDURAZYME. No correlation was demonstrated between the presence of IgG anti-ALDURAZYME antibodies and therapeutic response (6 MWT and FVC) or the occurrence of allergic reactions. Potential for antibody neutralization of cellular uptake has not been assessed. No consistent association was demonstrated between the presence of antibodies that neutralize enzymatic activity and therapeutic response. The data reflect the percentage of patients whose test results were considered positive for antibodies to ALDURAZYME using a specific enzyme-linked immunosorbent assay (ELISA) and confirmed by radio-immunoprecipitation (RIP). ALDURAZYME IgG antibodies were reported as titers. Drug specific antibody was detected in 42 of the 45 patients (93.3%) treated in Study 1 and Study 2. The mean time to seroconversion was 51 days in patients 6 years and older. In Study 3, all patients (100%) 5 years old or younger developed IgG antibodies against ALDURAZYME with a mean time to seroconversion of 26 days [see Clinical Studies (14) for the Study populations]. Nine patients in Study 1 and Study 2, collectively, who experienced severe infusion reactions were tested for ALDURAZYME-specific IgE antibodies and complement activation. IgE testing was performed by ELISA, and complement activation was measured by the Quidel Enzyme Immunoassay. One of the nine patients had an anaphylactic reaction consisting of urticaria and airway obstruction and tested positive for both ALDURAZYME-specific IgE binding antibodies and complement activation. None of the patients in the open-label clinical study of patients 5 years old or younger (Study 3) tested positive for IgE. Other allergic reactions were also seen in patients receiving ALDURAZYME [see Adverse Reactions (6)]. In the postmarketing setting, approximately 1% of patients experienced severe or serious infusion allergic reactions and tested positive for IgE. Of these IgE-positive patients, some have discontinued treatment, but some have been successfully re-challenged. The clinical significance of IgE antibodies has not been established. As with all the therapeutic proteins, there is potential for immunogenicity. The incidence of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to ALDURAZYME with the incidence of antibodies to other products may be misleading. 6.3 Postmarketing Experience The following adverse reactions have been identified during post approval use of ALDURAZYME. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. In postmarketing experience with ALDURAZYME, severe and serious infusion reactions have been reported, some of which were life-threatening, including anaphylactic shock [see Boxed Warning and Warnings and Precautions (5)] and laryngeal edema. Adverse reactions resulting in death reported in the postmarketing setting with ALDURAZYME treatment included cardiorespiratory arrest, respiratory failure, cardiac failure, and pneumonia. These events have been reported in MPS I patients with significant underlying disease. Additional adverse reactions included fatigue, edema peripheral, erythema and cyanosis. There have been a small number of reports of extravasation in patients treated with ALDURAZYME. There have been no reports of tissue necrosis associated with extravasation. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category B. A developmental toxicity study has been performed in rats at doses up to 6.2 times the human dose and has revealed no evidence of impaired fertility or harm to the fetus due to ALDURAZYME. However, there are no adequate and well-controlled studies of ALDURAZYME in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Pregnant women with MPS I should be encouraged to enroll in the MPS I Registry. For more information, visit www.MPSIregistry.com or call (800) 745-4447 [see Patient Counseling Information (17)]. 8.3 Nursing Mothers It is not known whether the drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when ALDURAZYME is administered to a nursing woman. Nursing mothers with MPS I should be encouraged to enroll in the MPS I Registry [see Patient Counseling Information (17)]. 8.4 Pediatric Use The safety and effectiveness of ALDURAZYME was assessed in a 52-week, open-label, uncontrolled clinical study in 20 patients with MPS I, ages 6 months to 5 years old, and was found to be similar to the safety and effectiveness of ALDURAZYME in pediatric patients 6 to 18 years, and adults [see Adverse Reactions (6) and Clinical Studies (14)]. 8.5 Geriatric Use Clinical studies of ALDURAZYME did not include patients aged 65 and over. It is not known whether they respond differently from younger patients. 10 OVERDOSAGE There have been no reports of overdose with ALDURAZYME. In clinical studies, a small number of patients received doses up to 1.2 mg/kg body weight once weekly or 1.8 mg/kg body weight every other week. Adverse events reported in patients receiving 1.2 mg/kg body weight once weekly or 1.8 mg/kg body weight every other week were similar to the adverse events reported by patients treated with 0.58 mg/kg body weight once weekly. 11 DESCRIPTION ALDURAZYME (laronidase) is a polymorphic variant of the human enzyme α‑l‑iduronidase that is produced by recombinant DNA technology in a Chinese hamster ovary cell line. α-l-iduronidase (glycosaminoglycan α-l-iduronohydrolase, EC 3.2.1.76) is a lysosomal hydrolase that catalyzes the hydrolysis of terminal α-l-iduronic acid residues of dermatan sulfate and heparan sulfate Laronidase is a glycoprotein with a molecular weight of approximately 83 kD. The predicted amino acid sequence of the recombinant form, as well as the nucleotide sequence that encodes it, are identical to a polymorphic form of human α-L-iduronidase. The recombinant protein is comprised of 628 amino acids after cleavage of the N-terminus and contains 6 N-linked oligosaccharide modification sites. Two oligosaccharide chains terminate in mannose-6-phosphate sugars. ALDURAZYME has a specific activity of approximately 172 U/mg. ALDURAZYME, for IV infusion, is supplied as a sterile, nonpyrogenic, colorless to pale yellow, clear to slightly opalescent solution that must be diluted prior to administration in 0.9% Sodium Chloride Injection, USP. The solution in each vial contains a nominal laronidase concentration of 0.58 mg/mL and a pH of approximately 5.5. The extractable volume of 5.0 mL from each vial provides 2.9 mg laronidase, 43.9 mg sodium chloride, 63.5 mg sodium phosphate monobasic monohydrate, 10.7 mg sodium phosphate dibasic heptahydrate, and 0.05 mg polysorbate 80. ALDURAZYME does not contain preservatives; vials are for single use only. 12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Mucopolysaccharide storage disorders are caused by the deficiency of specific lysosomal enzymes required for the catabolism of glycosaminoglycans (GAG). Mucopolysaccharidosis I (MPS I) is characterized by the deficiency of α-L-iduronidase, a lysosomal hydrolase which catalyzes the hydrolysis of terminal α-L-iduronic acid residues of dermatan sulfate and heparan sulfate. Reduced or absent α-L-iduronidase activity results in the accumulation of the GAG substrates, dermatan sulfate and heparan sulfate, throughout the body and leads to widespread cellular, tissue, and organ dysfunction. The rationale of ALDURAZYME therapy in MPS I is to provide exogenous enzyme for uptake into lysosomes and increase the catabolism of GAG. ALDURAZYME uptake by cells into lysosomes is most likely mediated by the mannose-6-phosphate-terminated oligosaccharide chains of laronidase binding to specific mannose-6-phosphate receptors. Because many proteins in the blood are restricted from entry into the central nervous system (CNS) by the blood brain barrier, effects of intravenously administered ALDURAZYME on cells within the CNS cannot be inferred from activity in sites outside the CNS. The ability of ALDURAZYME to cross the blood brain barrier has not been evaluated in animal models or in clinical studies. 12.2 Pharmacodynamics The pharmacodynamic effect of ALDURAZYME was assessed by reductions in urinary GAG levels. The responsiveness of urinary GAG to dosage alterations of ALDURAZYME is unknown, and the relationship of urinary GAG to other measures of clinical response has also not been established [see Clinical Studies (14)]. 12.3 Pharmacokinetics The pharmacokinetics of laronidase were evaluated in 6 year old or older patients (N = 10 to 12) with MPS I who received 0.58 mg/kg of body weight once weekly of ALDURAZYME as a 4-hour infusion in the placebo-controlled clinical study (Study 1). After the 1st, 12th, and 26th weekly infusions, the mean maximum plasma concentrations (Cmax) ranged from 1.2 to 1.7 μg/mL for the 3 time points. The mean area under the plasma concentration-time curve (AUC∞) ranged from 4.5 to 6.9 μg • hour/mL. The mean volume of distribution (Vz) ranged from 0.24 to 0.60 L/kg. Mean plasma clearance (CL) ranged from 1.7 to 2.7 mL/min/kg, and the mean elimination half-life (t1/2) ranged from 1.5 to 3.6 hours. Most patients who received once weekly infusions of ALDURAZYME in Study 1 developed antibodies to laronidase by Week 12. Between Weeks 1 and 12, increases in the plasma clearance of laronidase were observed in some patients and appeared to be proportional to the antibody titer. At Week 26, plasma clearance of laronidase was comparable to that at Week 1, in spite of the continued and, in some cases, increased titers of antibodies. The pharmacokinetics of laronidase were evaluated in 6 year old or younger patients (N=7 to 9) with MPS I disease who received 0.58 mg/kg of body weight once weekly of ALDURAZYME as a 4-hour infusion in the open label clinical study (Study 3). After the 26th infusion, the 95% confidence interval of the geometric mean values of PK parameters ranged from 0.6 to 1.6 µg/mL for the maximum plasma concentrations (Cmax), from 1.3 to 4.4 µg • hour/mL for area under the plasma concentration-time curve (AUC∞), from 0.12 to 0.56 L/kg for volume of distribution (Vz), from 2.2 to 7.7 mL/min/kg for plasma clearance (CL), and from 0.3 to 1.9 hours for elimination half-life (t1/2). 13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Studies to assess the mutagenic and carcinogenic potential of laronidase have not been conducted. Laronidase at IV doses up to 3.6 mg/kg (6.2 times the human dose) was found to have no effect on the fertility and reproductive performance of male and female rats. 14 CLINICAL STUDIES The safety and efficacy of ALDURAZYME were assessed in three clinical studies. 14.1 Clinical Studies in Patients 6 Years and Older Study 1 was a randomized, double-blind, placebo-controlled study in 45 patients with MPS I, ages 6 to 43 years old, including 1 patient with the Hurler form, 37 patients with Hurler-Scheie form, and 7 patients with Scheie form of MPS I. All patients had a baseline percent predicted forced vital capacity (FVC) less than or equal to 77%. Patients received ALDURAZYME at 0.58 mg/kg of body weight once weekly or placebo once weekly for 26 weeks. All patients were treated with antipyretics and antihistamines prior to each infusion. The primary efficacy outcome assessments were percent predicted FVC and distance walked in 6 minutes (6-minute walk test). After 26 weeks, patients treated with ALDURAZYME showed improvement in percent predicted FVC and in 6-minute walk test compared to placebo-treated patients (see Table 4). Table 4: Primary Efficacy Outcomes in the Placebo-controlled Study (Study 1)
Study 2 was a 182-week, open-label, uncontrolled extension study of all 45 patients who completed Study 1. Patients received ALDURAZYME at 0.58 mg/kg body weight once weekly. For patients treated with ALDURAZYME, the mean increase in 6-minute walk test distance was maintained for an additional 182 weeks through completion of Study 2. At the end of Study 2, the decrease in mean urinary GAG was similar to the decrease in urinary GAG reported in ALDURAZYME-treated patients at the end of Study 1. The relationship of urinary GAG to other measures of clinical response has not been established. 14.2 Clinical Studies in Patients 6 Years and Younger Study 3 was a 52-week, open-label, uncontrolled clinical study in 20 patients with MPS I, ages 6 months to 5 years old (at enrollment), including 16 patients (80%) with the Hurler form and 4 patients (20%) with the Hurler-Scheie form. All 20 patients received ALDURAZYME at 0.58 mg/kg of body weight once weekly for 26 weeks. After 26 weeks of treatment, 16 patients continued to receive 0.58 mg/kg of body weight once weekly through Week 52, and 4 patients received 1.16 mg/kg of body weight once weekly from Week 26 through Week 52. Reduction in mean urinary GAG was demonstrated at Week 13 and was maintained through Week 52. No patient receiving ALDURAZYME reached the normal range for urinary GAG levels during this 52-week study. Changes in urinary GAG levels in children 6 years and younger were similar to changes reported in older patients in Studies 1 and 2 (6 through 43 years old). The relationship of urinary GAG to other measures of clinical response has not been established. 16 HOW SUPPLIED/STORAGE AND HANDLING ALDURAZYME is supplied as a sterile solution in single-use, clear Type I glass 5 mL vials, containing 2.9mg laronidase per 5mL solution. The closure consists of a siliconized butyl stopper and an aluminum seal with a plastic flip-off cap. NDC 58468-0070-1, 5mL vial Refrigerate vials of ALDURAZYME at 2° to 8°C (36° to 46°F). Do not freeze or shake. Protect from light. Do not use ALDURAZYME after the expiration date on the vial. This product contains no preservatives. 17 PATIENT COUNSELING INFORMATION Patients should be counseled that allergic reactions may occur during ALDURAZYME treatment, including life-threatening anaphylaxis. Premedication and reduction of infusion rate may alleviate those allergic reactions associated with the infusion. The appropriate length of post-infusion monitoring is to be determined by the treating physician based on the individual patient’s clinical status and infusion history [see Warnings and Precautions (5)]. Patients should be advised to report any adverse reactions experienced while on ALDURAZYME treatment. It is unknown how ALDURAZYME affects women during pregnancy, labor and delivery or while nursing, as no adequate and well-controlled clinical studies have been conducted in these patient populations [see Use in Specific Populations (8)].The full benefits of ALDURAZYME may not be evident for several months to years of treatment. To maintain treatment benefit, ALDURAZYME should be administered on a weekly basis as indicated. Patients should be informed that a registry for MPS I patients has been established in order to better understand the MPS I disease, and to track clinical outcomes of patients with MPS I over time. Patients should be encouraged to participate, and advised that their participation is voluntary and may involve long-term follow-up. Information regarding the registry program may be found at www.MPSIregistry.com or by calling (800) 745-4447. 附：小儿糖原贮积病Ⅰ型诊断与治疗 病因 糖原是由葡萄糖构成的高分子多糖，主要贮存在肝脏和肌肉中作为备用能量，正常肝和肌组织中分别含有约4%和2%糖原。摄入体内的葡萄糖在葡萄糖激酶、葡糖磷酸变位酶和尿苷二磷酸葡糖焦磷酸化酶的催化下形成尿苷二磷酸葡萄糖（UD-PG）。然后在糖原合成酶和分支酶的作用下，形成树状结构的糖原大分子。糖原的分解主要由磷酸化酶和脱支酶的反复作用下形成葡萄糖，或在葡萄糖苷酶的催化下分解为麦芽糖等低聚糖。上述糖原合成和分解过程中任一酶的缺陷即导致不同临床表现的各型糖原贮积病。 GSD-Ⅰ是由于肝、肾等组织中葡萄糖-6-磷酸酶系统活力缺陷，造成过多的糖原贮积于其中，不仅导致其体积增大，而且功能也遭受损害。 临床表现 本型患儿临床表现轻重不一，重症在新生儿期即可出现严重低血糖、酸中毒、呼吸困难和肝脏增大等症状；轻症病例则常在婴幼儿期因生长迟缓、腹部膨胀等而就诊。由于慢性乳酸酸中毒和长期胰岛素/胰高糖素比例失常，患儿身材明显矮小，骨龄落后，骨质疏松。腹部因肝脏持续增大而显著膨隆；肌肉松弛，四肢伸侧皮下常有黄色瘤可见；但身体各部比例和智能等都正常。患儿时有低血糖发作和腹泻发生。少数婴幼儿在重症低血糖时尚可伴发惊厥，但亦有血糖降至0.56mmol/L（10mg/dl）以下而无明显症状者，随着年龄的增长，低血糖发作次数可以减少。由于血小板功能不良，患儿常有鼻出血等出血倾向。 检查 1.空腹血生化检测 生化异常包括低血糖、酮症酸中毒、乳酸血症及高脂血症。重症低血糖常伴有低磷血症。三酰甘油、胆固醇脂肪酸和尿酸均显著增高 2.糖耐量试验 呈现典型的糖尿病特征。患儿空腹血糖低而果糖耐量试验和半乳糖耐量试验特异性增高。由于患儿不能使半乳糖或果糖转化为葡萄糖，因此在半乳糖或果糖耐量试验中血葡萄糖水平不见升高。 3.肾上腺素试验 皮下注射1∶1000肾上腺素0.02ml/kg，注射前和注射后10，20，30，40，50，60分钟，分别测血糖，正常者血糖上升40%～60%；糖原贮积病患儿血糖无明显上升。 4.胰高血糖素试验 胰高糖素或肾上腺素试验亦不能使患儿血糖明显上升。糖肌注胰高血糖素30µg/kg（最大量1mg），于注射后0，15，30，45，60，90，120分钟分别取血测血糖。正常时15～45分钟内血糖升高1.5～2.8mmol/L，原贮积病葡萄糖-6-磷酸酶缺乏时在空腹或餐后均无血糖升高。 5.黏多糖检查 （1）血黏多糖检查 黏多糖末梢血白细胞，淋巴细胞和骨髓血细胞中可见到异染的大小不等、形状不同的深染颗粒，有时呈空泡状，颗粒称Reilly氏颗粒，经证实为黏多糖。 （2）尿黏多糖酸检查 患儿尿中排出大量酸性黏多糖，可超过100mg/24小时（正常为3～25mg/24小时），尿中排出硫酸皮肤素和类肝素。 6.活组织检查 （1）肝脏活组织检查 可见肝细胞增大糖原增加；葡萄糖-6-磷酸活性酶降低或消失。 （2）肌肉活组织检查 糖原含量稍增加糖原结构正常血小板中葡萄糖-6-磷酸活性酶亦可降低或消失。 7.酶检查 可测定尿中各种酶的活性，各型黏多糖增多症均有相应的酶活性降低。患儿白细胞成纤维细胞或肝细胞，尿中缺乏α-艾杜糖醛酸酶。 8.基因检测 可通过外周血白细胞DNA分析进行基因检测。 9.血小板膜检查 血小板膜释放ADP能力减低，因此其黏附率和聚集功能低下。多数患儿肝功能正常。 10.影像学检查 X线检查可见骨质疏松和肾脏肿大。背柱、头颅X线示仅有轻微改变。 B超和CT扫描可发现肝、肾肿大，少数病程较长患儿肝脏并发有单个或多个腺瘤。 诊断 根据病史、体征和血生化检测可供做出初步临床诊断，糖代谢功能试验可能有助于诊断。以肝组织的糖原定量和葡萄糖-6-磷酸酶活性测定作为确诊依据。 治疗 在空腹低血糖时，由于胰高糖素的代偿机制促进了肝糖原分解，导致患儿体内6-磷酸葡萄糖累积和由此生成过量的乳酸、三酸甘油酯和胆固醇等一系列病理生化过程。因此，从理论上讲，任何可以保持正常血糖水平的方法即可阻断这种异常的生化过程并减轻临床症状。 1.药物治疗 维生素类药物，如B族维生素、维生素C等。有感染给抗生素治疗。 2.手术治疗 做门-腔静脉吻合术改善本病的生化异常。 3. 特异性的酶替代治疗及基因治疗 最有希望治疗黏多糖增多症的方法是特异性的酶替代治疗药物ALDURAZYME(LARONIDASE)及基因治疗，二者可改善患儿的临床表现以及生存情况。 特异性酶替代治疗可有两种不同的形式。一种是直接给体内输入经过微包裹的酶，此为直接法。另一种则为间接法，即利用反转录病毒进行转基因处理，使患儿自体的周围血淋巴细胞或骨髓造血祖细胞逆向转化为含有正常酶基因的细胞，或通过骨髓移植给患儿体内植入含有正常酶基因的骨髓细胞，从而使患儿体内可以自身合成所缺乏的黏多糖代谢酶。 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
