Wilson病基因突变类型与临床表型的关系

目的 探讨Wilson病（WD）基因突变类型与临床表型的关系。方法 应用聚合酶链反应-单链构象多态分析（PCR-SSCP）和DNA测序方法,对84例WD患者进行WD基因全长21个外显子的突变检测。结合统计学方法,着重分析并探讨中国人WD基因突变热点Arg778Leu基因型与临床表型的关系。结果 18例患者检出Arg778Leu纯合突变。29例患者在一条染色体上检出Arg778Leu杂合错义突变。其中,在另一条染色体上,3例检出移码突变;15例突变未明;余11例检出其他错义突变。就理论而言。与错义突变相比。移码突变可导致更严重的功能缺陷及表型。不能与错义突变混合进行统计学分析。另15例患者因有一条染色体突变未明亦被排除在外。因此,相对Arg778Leu纯合错义突变进行统计学分析时,只能选择11例发生复合错义突变的患者做为Arg778Leu杂合突变病例组。经统计学分析。携带Arg778Leu纯合突变的患者和携带Arg778Leu杂合突变的患者,其起病年龄,血清铜蓝蛋白水平及临床类型均差异有显著意义,P值小于0.05或0.001。结论 Arg778Leu突变不是一种温和的突变。它可导致患者症状出现较早并较严重。

Genotype-phenotype correlation of patients with wilson disease in Chinese population

Objective To investigate the correlation between genotype and phenotype of patients with Wilson disease (WD) in the Chinese population. Methods Using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and subsequent direct sequencing to identify the mutations of ATP7B. Statistical analysis was performed using t test or x2 test. Results The common mutation Arg778Leu was homozygous in 18 patients. It was also found to be heterozygous in 29 patients. 11 of 29 patients who carried another missense mutation in the other chromosome were regarded as Arg778Leu compound heterozygotes. We observed that the average age at onset in Arg778Leu homozygotes was significantly younger than that in Arg778Leu compound heterozygotes ( P < 0.05). The average ceruloplasmin level of Arg778Leu homozygotes was significantly lowerthan that of Arg778Leu compound heterozygotes (P < 0.001) . Conclusion The result shows that Arg778Leu homozygotes are associated with the early onset of WD with hepatic presentation. The Arg778Leu mutation is not a mild mutation. It has severe effects on the function of ATP7B.