维吾尔族和汉族散发性乳腺癌患者BRCA1/2基因突变的检测

目的探讨新疆维吾尔族和汉族散发性乳腺癌患者乳腺癌易感基因1/2(BRCA1/2)突变情况及与临床病理参数的关系。方法采用PCR和DNA直接测序法,对新疆地区230例散发性乳腺癌患者(维吾尔族、汉族各115例)石蜡组织进行BRCA1基因第2、11(11A和11B)、20号外显子和BRCA2基因第11号部分外显子,共5对引物进行突变检测。结果 230例乳腺癌患者中,BRCA基因突变率为6.96%(16/230),其中1例BRCA1基因-5 382位点的突变及7例新发突变位点;维吾尔族和汉族患者中BRCA基因突变检出率分别为7.83%(9/115)和6.09%(7/115);BRCA基因突变组发病年龄均≤50岁;突变组16例患者中绝经前患者(13例)的突变率明显高于绝经后患者(3例)(P0.05)。结论 BRCA1基因突变可能与新疆地区散发性乳腺癌发生相关。     

非小细胞肺癌表皮生长因子受体、间变性淋巴瘤激酶、ROS1基因突变及突变共存的临床病理学意义

目的探讨非小细胞肺癌表皮生长因子受体(EGFR)基因突变、间变性淋巴瘤激酶(ALK)及ROS1基因融合突变情况与临床病理特征的关系,并分析驱动基因共突变的病例。方法收集福建医科大学附属协和医院1508例非小细胞肺癌患者临床病理资料,采用荧光PCR法检测EGFR基因突变及ALK、ROS1基因融合突变情况,统计分析驱动基因突变状态与临床病理特征的关系。结果1508例非小细胞肺癌中,EGFR、ALK、ROS1基因突变率分别为52.9%(797/1508)、6.2%(93/1508)、2.7%(40/1508);EGFR基因突变类型以外显子19 del与外显子21 L858R为主(90.6%,722/797),EGFR基因突变多见于女性、无吸烟史、腺癌患者(P<0.05);ALK及ROS1基因融合多见于年龄<60岁、晚期患者(P<0.05)。其中携带共突变基因的非小细胞肺癌患者共16例(1.1%,16/1508),包括EGFR/ALK基因共突变7例、EGFR/ROS1基因共突变8例、ALK/ROS1基因共突变1例,驱动基因共突变患者多为女性、腺癌患者。16例驱动基因共突变患者中,8例使用酪氨酸激酶抑制剂治疗,疗效为3例部分缓解、2例疾病稳定、3例疾病进展。结论非小细胞肺癌驱动基因可出现突变共存的状态,多基因联合检测可为临床靶向药物治疗策略的制定提供参考意义。     

结节性硬化症患儿基因突变规律及其与临床表型关系

目的:检测结节性硬化症(TSC)患儿TSC1,TSC2基因突变类型,探讨其基因突变规律以及基因型与临床表型关系,为TSC分子遗传学研究提供资料。方法:收集2014~2016年徐州市儿童医院神经内科门诊及住院临床诊断为TSC患儿24例,提取血液标本的基因组DNA,二代基因测序技术(illumina/Solexa平台)进行检测。结果:(1)24例TSC患儿中23例检测到基因突变,突变率95.83%,其中TSC1基因突变4例(4/23,17.39%),TSC2基因突变19例(19/23,82.61%),新发突变18例(18/23,78.26%)。(2)TSC基因突变类型包括移码突变、错义突变、无义突变、剪切突变,大片段缺失,除2例患儿突变位点相同外,余均不相同。(3)TSC1基因突变患儿均为家族型,TSC2基因突变患儿5例为家族型(5/19,26.31%)。(4)癫痫发作类型TSC2基因突变患儿以痉挛发作为主(13/19,68.42%),TSC1基因突变患儿以局灶性发作为主(3/4,75.00%);癫痫3月完全控制率TSC2基因突变患儿为46.00%,TSC1基因突变患儿为75.00%,明显高于TSC2基因突变患儿(P0.01)。(5)TSC2基因突变患儿中智力发育落后(15/19,78.94%)明显多于TSC1基因突变患儿(1/4,25.00%,P0.01)。结论:TSC基因突变率较高,以TSC2为主,且无明显突变热点,新发突变多见。TSC1基因突变以家族型为主,TSC2基因突变以散发型为主。TSC2基因突变患儿临床表型相对TSC1基因突变患儿严重。     

二例先天性肌强直的CLCNl基因突变研究

目的 探讨2例先天性肌强直患者的氯离子通道蛋白-1(chloride channcl 2,CLCN1)基因突变情况和临床特点.方法 收集福建地区1个先天性肌强直家系的先证者和1例散发性先天性肌强直患者的临床资料并进行综合分析.用PCR扩增患者CLCN1基因的全部外显子,通过直接测序检测突变的情况.结果 家系1先证者的CLCN1基因第8外显子存在c.1024 G>A的杂合性错义突变,散发性患者的CLCN1基因第11外显子发现了c.1292 C>T的杂合性错义突变.结论 先天性肌强直症临床表现缺乏特异性,CLCN1基因突变检测是确诊该病的有效方法.     

湖南省9957例新生儿遗传性耳聋基因突变筛查分析

目的分析湖南省新生儿常见的遗传性耳聋基因携带率及突变谱,为临床耳聋疾病防治、生育咨询指导提供理论依据及数据支持。方法收集湖南长沙市、岳阳市、娄底市等10个地区共9957例新生儿足跟血血斑,采用微阵列芯片法(九项遗传性耳聋基因检测试剂盒)对中国人群常见4种耳聋基因突变进行筛查,包括GJB2基因35 del G、176_191 del16、235 del C和299_300 del AT;SLC26A4基因IVS 7-2 AG和2168 AG;线粒体12S r RNA基因1555 AG和1494 CT,GJB3基因538 CT)。结果基因芯片检测共发现366例耳聋基因突变,其中GJB2的突变携带者225例,235纯合突变1例,突变携带率2.26%(225/9957);SLC26A4基因突变携带者88例,2168 AG纯合突变1例,突变携带率0.88%(88/9957);线粒体12S r RNA基因突变携带者38例,突变携带率0.38%(38/9957);GJB3基因突变携带者10例,突变携带率0.1%(10/9957);双突变4例,双突变携带率0.04%(4/9957),分别是235杂合/1555均质1例,235/2168复合杂合1例,235 del C/IVS 7-2 AG双杂合突变2例。结论湖南省新生儿耳聋基因突变检测结果中,GJB2基因突变检出率最高,其次SLC26A4基因突变,GJB3最少。     

散发性SDH缺陷型胃肠道间质瘤26例临床及分子病理学特征

目的观察散发性琥珀酸脱氢酶(succinate dehydrogenase, SDH)缺陷型胃肠道间质瘤(gastrointestinal stromal tumor, GIST)的临床病理特点、免疫表型、分子遗传学改变,并探讨潜在的分子机制。方法采用甲基化特异性PCR、直接测序法检测26例散发性SDH缺陷型GIST,并分析其临床病理学、免疫表型及分子遗传学特点。结果 26例GIST中15例(57.69%)存在至少一项SDH基因异常,38.46%(10/26)检测到SDHB、SDHC、SDHD基因突变,其中3例双突变。甲基化特异性PCR技术检测出38.46%(10/26)病例发生基因启动子甲基化:SDHA基因8例,SDHB基因3例,其中1例同时甲基化。结论通过分析SDH缺陷型GIST的形态学特征、免疫表型和分子生物学特征,提示SDH基因突变及甲基化均是肿瘤抑制因子失活的重要机制,在肿瘤发生、发展中发挥重要作用。SDH突变与SDH启动子甲基化同时发生,提示存在基因多种异常共同作用的可能性。     

非小细胞肺癌患者肿瘤组织中EGFR和KARS基因突变的分子病理检测分析

目的：探讨非小细胞肺癌患者肿瘤组织中EGFR和KRAS基因各亚型突变情况。方法：应用直接测序方法检测非小细胞肺癌石蜡组织中1273例EGFR基因和1062例KRAS基因突变情况。结果：非小细胞肺癌肿瘤组织中EGFR基因总突变率为36.68%(467/1273),外显子18、19、20和21的突变率分别为1.02%(13/1273)、18.93%(241/1273)、2.59%(33/1273)和15.95%(203/1273);EGFR基因各外显子之间双重突变共17例(1.34%),其中18外显子与20外显子双重突变3例(0.24%),19外显子与20外显子双重突变7例(0.55%),19外显子与21外显子双重突变4例(0.31%)和20外显子与21外显子双重突变3例(0.24%);EGFR基因各外显子内双重突变共2例(2.18%),均为21外显子双重突变。KRAS基因总突变率为3.01%(32/1062),外显子2的密码子5、12、13和25的突变率分别为0.09%(1/1062)、2.64%(28/1062)、0.18%(2/1062)和0.09%(1/1062),外显子3密码子61的突变率为0.09%(1/1062)。结论：非小细胞肺癌患者中EGFR基因存在较高的突变率,尤其为19和21外显子突变,其基因突变亚型分类能指导EGFR-TKI的肿瘤靶向治疗,KRAS基因突变率虽低但不容忽视,其基因突变预示着EGFR-TKI原发耐药。     

云南地区非小细胞肺癌患者外周血EGFR基因突变与临床病理特征的关系

目的探讨云南地区非小细胞肺癌外周血中表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变及与临床病理特征的关系,为该地区的肺癌个体化靶向治疗奠定基础。方法应用突变扩增阻滞系统(amplification refractory mutation system,ARMS)检测非小细胞肺癌(non-small cell lung cancer,NSCLC)外周血中EGFR基因第18、19、20及2l外显子突变情况,统计分析各类突变与患者临床病理特征的相关性。结果在364例患者中,EGFR基因突变者93例(25.5%)。其中EGFR 18 G719X突变占3.2%(3/93),EGFR 19缺失突变占48.4%(45/93),EGFR 20 S768I、T790M、20ins突变分别占3.2%(3/93)、2.2%(2/93)、3.2%(3/93),EGFR 21 L858R、L861Q突变分别占26.9%(25/93)、1.1%(1/93);双突变比例占11.8%,其中3例样本3.2%(3/93)存在G719X、S768I双突变,4例样本4.3%(4/93)存在19Del、T790M双突变,1例样本1.1%(1/93)存在19Del、L858R双突变,1例样本1.1%(1/93)存在L858R、S768I双突变,2例样本2.2%(2/93)存在S768I、T790M双突变。EGFR基因突变与患者性别、临床分期、组织学类型相关(P0.005),而与患者年龄、是否吸烟无明显相关(P0.05)。结论云南地区ⅢB~Ⅳ期NSCLC患者外周血中,女性腺癌突变率较高,且该地区NSCLC患者外周血EGFR基因突变存在外显子19缺失突变为主及双突变率较高的特征。使用ARMS技术检测NSCLC患者外周血EGFR基因突变可为临床使用EGFR-TKIs提供准确的指导。     

胃癌组织中HER-2基因扩增和K-ras基因突变的关系

目的探讨胃癌组织中HER-2蛋白表达和基因扩增与K-ras基因突变的关系及其意义。方法采用免疫组化、FISH和焦磷酸测序技术对67例胃癌组织中HER-2蛋白表达、HER-2基因扩增与K-ras基因的突变率进行了检测。结果 HER-2蛋白阳性率为40.3%(27/67),其中HER-2蛋白3+者9.0%(6/67),HER-2蛋白2+者13.4%(9/67),HER-2蛋白1+者17.9%(12/67)。FISH检测HER-2基因扩增率为18.5%(5/27),HER-2基因拷贝数增加和基因扩增者共48.1%(13/27)。K-ras基因突变定量检测为7.5%(5/67),均为K-ras基因第12密码子突变,其中低于10%低丰度突变2例,高于10%高丰度突变3例(突变数值分别为:17、29、30)。除1例为GGT→GAT突变型外,其它均为GGT→GTT突变型。本组K-ras基因突变5例中除1例既有K-ras基因突变,又有HER-2基因扩增,另外4例HER-2基因均无扩增。结论检测胃癌中HER-2扩增时选用抗肿瘤药物治疗的靶点曲妥珠单抗,同时可选用K-ras基因突变的抗肿瘤药物治疗的靶点西妥昔单抗;联合检测胃癌组织中HER-2基因扩增和K-ras基因突变为靶向抗肿瘤药物治疗过程中受益提供参考指标。     

非小细胞肺癌患者肿瘤组织多驱动基因联合检测及其临床意义

目的探讨EGFR、KRAS基因突变及ALK、ROS1基因融合在非小细胞肺癌(non-small cell lung cancer,NSCLC)患者中的检出率,并分析与NSCLC临床病理特征的关系。方法收集NSCLC手术标本86例,采用荧光PCR法检测EGFR、KRAS突变及ALK、ROS1基因融合,并分析EGFR、KRAS、ALK及ROS1基因改变与患者性别、年龄、吸烟史、组织学类型、有无淋巴结转移等临床病理特征的相关性。结果 NSCLC肿瘤组织中驱动基因总突变率为62.8%(54/86),其中EGFR基因突变占总突变的76.0%(41/54);KRAS基因突变占总突变的9.3%(5/54);ALK基因融合占总突变的13.0%(7/54),其中1例患者存在EGFR 19缺失突变与ALK融合共存;ROS1基因融合占总突变的3.8%(2/54)。NSCLC的临床病理特征显示,EGFR基因突变在女性、腺癌患者中突变率高(P0.05);与患者年龄、是否吸烟、有无淋巴结转移无明显相关(P0.05);KRAS、ALK、ROS1基因改变与NSCLC的临床病理特征无明显相关(P0.05)。结论 NSCLC中EGFR、ALK基因均存在较高的突变率,临床医师应给予高度重视;KRAS、ROS1基因改变以及驱动基因双突变共存型基因突变率虽低,但其意义重大不容忽视。     

Detection of the first gross CDC73 germline deletion in an HPT-JT syndrome family

Hereditary primary hyperparathyroidism (HPT) may develop as a solitary endocrinopathy (FIHP) or as part of multiple endocrine neoplasia Type 1, multiple endocrine neoplasia Type 2A, or hereditary HPT-jaw tumor syndrome. Inactivating germline mutations of the tumor suppressor gene CDC73 account for 14 and 50% of all FIHP and HPT-JT patients, respectively, and have also been found in almost 20% of apparently sporadic parathyroid carcinoma patients. Although more than 60 independent germline mutations have been described, to date no rearrangement affecting the CDC73 locus has been identified. By means of multiplex-PCR we found a large germline deletion affecting the whole gene in a two-generation HPT-JT family. Subsequently array-CGH and specific PCR analysis determined that the mutation spanned ～ 547 kb, and included four additional genes: TROVE2, GLRX2, B3GALT2, and UCHL5. Although no clear mutation-specific phenotype was found associated to the presence of the mutation, further studies are needed to assess whether the loss of the neighboring genes could modify the phenotype of carriers. There was complete absence of nuclear staining in the two HPT-JT-related tumors available. The finding of the first rearrangement affecting the CDC73 gene warrants screening for this tumor suppressor gene inactivation mechanism not only in high-risk CDC73 point mutation-negative HPT-JT families, but also in FIHP patients.     

A Novel Mutation in a Patient with Hyperparathyroidism–Jaw Tumour Syndrome

Hyperparathyroidism–jaw tumour syndrome (HPT-JT) is a rare variant of familial hyperparathyroidism, characterized by primary hyperparathyroidism (PHPT) due to one or multiple parathyroid adenomas, and benign tumours of the mandible and maxilla. It has an autosomal dominant pattern of inheritance, and is associated with mutations that deactivate the cell division cycle protein 73 homolog (CDC73) gene, also known as hyperparathyroidism 2 (HRPT2), located on the long arm of chromosome 1, that encodes for the tumour suppressor protein parafibromin. In the majority of cases, PHPT is the presenting symptom, but up to 30 % of HPT-JT cases initially present with an ossifying fibroma of the maxillofacial bones. HPT-JT may result in severe hypercalcemia-related complications and an elevated risk of parathyroid carcinoma. For this reason, early identification of the disease is important. We present the case of a 23-year-old woman who was found to have jaw tumours and was later diagnosed with PHPT. Genetic analysis revealed a novel mutation in exon 1 of CDC73. This report contributes to the understanding of the genetics of this rare syndrome. It also highlights the fact that HPT-JT should be considered and CDC73 mutation analysis should be performed in cases of early-onset PHPT associated with ossifying fibromas of the jaw.     

Mutational analysis of the NF2 gene in sporadic meningiomas by denaturing high-performance liquid chromatography

The NF2 tumor suppressor gene, located in chromosome 22q12, is involved in the development of sporadic meningiomas of the nervous system. In order to evaluate the role of the NF2 gene in sporadic meningiomas, we analyzed the entire coding regions of the NF2 gene in a group of 42 sporadic meningiomas: 17 meningothelial, 11 transitional, 11 fibrous, one secretory, one atypical, and one malignant subtype, using denaturing high-performance liquid chromatography (DHPLC) and sequence analysis. Twenty-one mutations were identified in 20 patients with an overall mutation detection rate of 47.6%. The mutations included nine deletions (exons 1, 2, 5, 10, and 12), resulting in a frameshift, four non-sense mutations (exons 1, 2, and 7), four splice errors (exons 4, 5, 7, and 12), two missense mutations (exon 5) and two silent mutations (exon 11). Among these, 14 novel mutations were also identified in the present study. All mutations were noted in the first 12 exons, the region of homology with the ezrin-moesin-radixin protein. Furthermore, an association between NF2 mutations and histologic subtypes were observed; NF2 mutations were more frequent in fibrous meningiomas (8/11, 73%) and transitional meningiomas (6/11, 55%), than in meningothelial variant (5/17, 29%). These results provide evidence that mutations in the NF2 gene play an important role in the development of sporadic meningiomas as well as indicating a different tumorigenesis of these meningioma variants.     

Comprehensive mutational analysis of the TSC1 gene: observations on frequency of mutation, associated features, and nonpenetrance

We performed a comprehensive analysis for mutations in the TSC1 gene using Southern blot analysis, and SSCP and heteroduplex analysis of amplified exons in 13 families with genetic linkage to the TSC1 region, 22 small families without linkage information, and 126 sporadic patients. 17 unique mutations were identified in 21 patients. Mutations were found in 7/13 (54%) TSC1-linked families, 1/22 (5%) small families without linkage, and 13 of 126 (10%) sporadic cases. The mutations were all chain-terminating, with 14 small deletions, 1 small insertion, and 6 nonsense mutations. In families with mutations, all individuals carrying a mutation met formal diagnostic criteria for TSC, apart from a 3-year-old girl who had inherited a deletion mutation, and who had no seizures, normal intelligence, normal abdominal ultrasound, and hypomelanotic macules only on physical exam. We assessed the incidence and severity of mental retardation in the 13 sporadic patients with TSC1 mutations versus the entire sporadic cohort, and found no significant difference. The observations indicate that TSC1 mutations are all inactivating, suggest that TSC1 disease occurs in only 15–20% of the sporadic TSC population, and demonstrate that presymptomatic TSC does occur.     

Molecular genetics of syndromic and non‐syndromic forms of parathyroid carcinoma

Parathyroid carcinoma (PC) may occur as part of a complex hereditary syndrome or an isolated (i.e., non‐syndromic) non‐hereditary (i.e., sporadic) endocrinopathy. Studies of hereditary and syndromic forms of PC, which include the hyperparathyroidism‐jaw tumor syndrome (HPT‐JT), multiple endocrine neoplasia types 1 and 2 (MEN1 and MEN2), and familial isolated primary hyperparathyroidism (FIHP), have revealed some genetic mechanisms underlying PC. Thus, cell division cycle 73 (CDC73) germline mutations cause HPT‐JT, and CDC73 mutations occur in 70% of sporadic PC, but in only ～2% of parathyroid adenomas. Moreover, CDC73 germline mutations occur in 20%–40% of patients with sporadic PC and may reveal unrecognized HPT‐JT. This indicates that CDC73 mutations are major driver mutations in the etiology of PCs. However, there is no genotype–phenotype correlation and some CDC73 mutations (e.g., c.679_680insAG) have been reported in patients with sporadic PC, HPT‐JT, or FIHP. Other genes involved in sporadic PC include germline MEN1 and rearranged during transfection (RET) mutations and somatic alterations of the retinoblastoma 1 (RB1) and tumor protein P53 (TP53) genes, as well as epigenetic modifications including DNA methylation and histone modifications, and microRNA misregulation. This review summarizes the genetics and epigenetics of the familial syndromic and non‐syndromic (sporadic) forms of PC.     

Mutational analysis of the RET proto-oncogene in 71 Japanese patients with medullary thyroid carcinoma

Multiple endocrine neoplasia types 2A and 2B (MEN2A and MEN2B) and familial medullary thyroid carcinomas (FMTC) are caused by germline mutations in the RET proto-oncogene. To investigate the spectrum of RET mutations among Japanese patients, we screened the RET gene in 71 patients with thyroid carcinomas. The panel included representatives of 44 families carrying FMTC or MEN2, 22 sporadic medullary thyroid carcinomas (MTCs), and five MTCs without familial information. Mutations in nucleotide sequences encoding one of three specific cysteine residues in the extracellular domain of the RET protein were found in 33 of the 34 MEN2A patients and in five of the six FMTC patients examined. A mutation at codon 918, causing the substitution of threonine for methionine in the tyrosine kinase domain of the protein, was found in germline DNAs of all four patients with MEN2B and in two of the 22 patients with sporadic MTCs; codon 918 was mutated somatically in tumor DNAs from three other sporadic cases. Germline mutations of codon 768, GAG to GAC (Glu to Asp), were detected in one FMTC, in one patient with sporadic MTC, and in one of the patients without familial information. Two somatic mutations, an Asp to Gly substitution at codon 631 and a Cys to Arg substitution at codon 634, had not been reported previously. Of five germline mutations found among the 22 sporadic cases, four were confirmed as de novo mutations since in each case neither parent carried the mutation. As nearly one-fourth of the patients with sporadic MTCs carried germline mutations and 50% of their children are expected to develop MTC and other endocrine tumors, these results indicated the importance of careful clinical surveillance of family members of any patient with MTC. Received: August 22, 1997 / Accepted: October 22, 1997     

Mutations in the dystrophin gene are associated with sporadic dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is the major indication for heart transplantation. Approximately 30% of all DCM is thought to be inherited, while 70% is sporadic. Mutations in the dystrophin gene have been associated with the uncommon X-linked form of DCM. We hypothesized that missense mutations and other less severe mutations of the dystrophin gene might predispose to the common form of sporadic DCM. To test this hypothesis, 22kb of genomic dystrophin DNA was scanned with DOVAM-S in each of the 22 patients with sporadic DCM, including all 79 coding sequences and splice junctions, as well as six alternative exon 1 dystrophin isoforms (484kb, total). Three putative new mutations (IVS5+1 G>T, K18N, and F3228L) and seven polymorphisms were identified. The splice site mutation IVS5+1 is predicted to cause skipping of exon 5, which is within a region containing an actin binding site. The missense mutations occur at amino acids that display substantial evolutionary conservation. Screening of 236 control individuals failed to identify these three mutations. The three patients with putative mutations had CK-MM (creatine kinase, skeletal muscle) levels greater than 250 units while the 14 patients without mutations for which CK-MM were available had values ranging from 20 to 200. The first comprehensive mutation scanning of the exons and splice junctions of the dystrophin gene in patients with sporadic DCM presents the evidence that point mutations are associated with sporadic DCM without clinical evidence of skeletal myopathy. It may be prudent to measure CK-MM in all patients with dilated cardiomyopathy to identify candidates at high risk for dystrophin mutations.     

海南西部地区乳腺癌患者 BRCA1 / 2 基因突变状态分析

目的 不同的区域及种族的 BRCA1 / 2 基因突变频率差异较大, 着重分析海南西部地区乳腺癌患 者 BRCA1 / 2 基因的突变状态及对患者预后的影响。 方法 选取 2015 年 10 月 ~ 2020 年 12 月在海南西部中 心医院住院并确诊为原发性乳腺癌的 256 例患者为研究对象, 采用变性高效液相色谱法 ( denaturing high performance liquid chromatography, DHPLC) 筛查乳腺癌患者是否存在 BRCA1 / 2 基因突变, 分析 BRCA1 / 2 基 因突变状态及 BRCA1 / 2 基因突变患者的临床特征, 并随访分析患者 5 年生存情况, COX 回归分析影响患者 预后的因素。 结果 256 例乳腺癌患者中共检出 53 例患者发生 BRCA1 / 2 基因突变, 其中 BRCA1 突变率 12. 11 % (31 / 256), BRCA2 突变率 8. 59 % (22 / 256), 其中有害变异率为 7. 03 % (18 / 256)。 BRCA1 / 2 基 因突变患者家族病史、 妇科疾病史、 乳腺疾病史、 雌激素受体 (estrogen receptor, ER)、 原癌基因 (CerbB2) 蛋白阳性比例以及临床病理分级、 临床分期与未突变患者比较差异有统计学意义 (P< 0. 05)。 患者总 体生存率为 83. 59 % , BRCA1 / 2 基因突变者生存率低于未突变者 (P< 0. 05), COX 回归分析显示, BRCA1 / 2 基因突变、 乳腺疾病史、 临床分期、 CerbB-2 阳性、 CEA、 CA199 均是影响乳腺癌患者生存的危险因素 (P< 0. 05)。 结论 通过 DHPLC 可有效筛查海南西部地区乳腺癌患者 BRCA1 / 2 基因的有害变异, BRCA1 / 2 基因突变与临床病理特征及预后密切相关。     

Investigation of UBE3A and MECP2 in Angelman syndrome (AS) and patients with features of AS

Angelman syndrome (AS) is an imprinted neurobehavioral disorder characterized by mental retardation, absent speech, excessive laughter, seizures, ataxia, and a characteristic EEG pattern. Classical lesions, including deletion, paternal disomy, or epigenetic mutation, are confirmatory of AS diagnoses in 80% of cases. Loss-of-function mutations of the UBE3A gene have been identified in approximately 8% of AS cases, failing to account for the remaining patient population, and there appears to be a higher prevalence of mutations in familial than sporadic cases. We screened UBE3A in 45 index cases of AS without obvious 15q11-13 abnormalities. Pathological mutations were identified in 3/6 (50%) familial and 4/39 (>10%) sporadic cases. By combining our data with those of the literature, we demonstrate statistically that the frequency of UBE3A mutations is significantly higher in the familial than sporadic subsets of AS. This indicates that an independent molecular mechanism or 'phenocopy' exists for the sporadic group. Rett syndrome (RS), caused by mutations of the MECP2 gene, and patients with deletions of 22q13.3 --> qter, have overlapping clinical features with AS. We screened 24 of the sporadic AS cases without detectable UBE3A mutations for mutations of MECP2, but found none. A separate cohort of 43 atypical patients with features common to AS and RS, in whom 15q11-13 lesions and 22q13.3 --> qter deletion had been ruled out, were also screened for MECP2 mutations. One male patient was mosaic for a frameshift mutation of this gene (previously reported). While MECP2 mutations can cause a phenotype reminiscent of AS in rare cases, they fail to account for the excess of sporadic patients with a definitive clinical diagnosis of AS.