携带 I2G 突变的 21 羟化酶缺乏症患儿基因突变谱与 临床表型的关系

目的探讨携带I2G基因突变的21羟化酶缺乏症(21-OHD)患儿基因突变谱,分析基因型与临床表型的关系。方法收集2009-2016年间收治的携带I2G基因突变的21-OHD患儿的临床资料,分析基因型与临床表型的关系。结果共26例患儿,男20例、女5例,失盐型(SW)22例(84.62%),单纯男性化型(SV)4例(15.38%)。I2G纯合突变16例(61.5%),除1例男童临床表现为SV外,其余15例均表现为SW。复合杂合突变10例(38.5%),其中7例为SW,分别携带有p.Q319X、p.R357W、p.R484P、p.V282L、Gll0fs、Cluster E6基因突变;1例SV女童携带p.I172N突变基因,另外2例SV男童(同胞兄弟)均携带p.Q319X突变及父源等位基因大片段重复,而母源等位基因上存在I2G杂合突变。结论携带I2G基因突变的21-OHD患儿基因型与临床表型有较好的一致性,纯合突变多表现为SW,复合杂合突变的临床表现主要取决于酶活性损害较轻的突变基因。     

暂时性甲状腺功能减低伴甲状腺肿大患儿DUOX2基因突变的研究

目的 研究暂时性先天性甲状腺功能减退伴甲状腺肿大患者DUOX2基因突变情况.方法 对5例暂时性甲状腺功能减低伴甲状腺肿大患者DUOX2基因的全部外显子进行基因突变筛查,基因突变类型和特点.结果 在1例先天性甲状腺功能减低症( Congenital Hypothyroidism,CH)患儿中发现DUOX2基因一个等位基因的杂合性突变,为第10外显子cDNA的1329位点发生C＞T的突变(c.C1329T),导致第376密码子精氨酸突变为色氨酸(p.Arg376Trp).其他4例CH患儿均没有发现DUOX2基因突变.结论 在先天性甲状腺功能减退患儿中也发现了DUOX2基因的p.Arg376Trp突变,该突变的单个等位基因剂量的改变可能导致先天性甲状腺功能减退.     

5例糖原贮积症Ⅸc型患儿临床和PHKG2基因突变分析

目的分析5例糖原贮积症(GSD)Ⅸc型患儿的临床、生化及基因突变特点。方法回顾分析5例GSD Ⅸc型患儿的临床情况,并采用靶向测序技术进行基因分析,Sanger测序验证所发现的PHKG2基因突变及其父母来源。结果5例患儿均表现为明显肝大和矮小,4例有运动耐力差;均有空腹低血糖,肝酶中重度升高,血三酰甘油升高;肝脏超声示无肝硬化。靶向测序发现5例患儿均携带PHKG2基因纯合或复合杂合致病或可能致病突变,发现1种已报道突变p.E157K和5种新突变(p.E56X,p.R185X,c.79_88delins TCTGGTCG,c.761del C,p.R279C),p.E157K为患儿的热点突变(50%)。结论靶向测序有助于确诊GSD Ⅸc型,p.E157K为热点突变。     

不典型严重联合免疫缺陷病 7 例诊治分析

目的探讨不典型严重联合免疫缺陷病(SCID)的诊断和治疗。方法回顾分析2012年9月-2017年6月证实为IL2RG、JAK3和RAG1突变的7例不典型SCID患儿的临床资料。结果 7例患儿中,婴儿5例,幼儿及学龄期儿童各1例;6例为男性、1例为女性。例2、4、6为经典SCID临床表型,例1、3、5、7为不典型SCID临床表型,例6临床诊断Omenn综合征。例2、5为经典SCID免疫表型,例1、3、4、6、7为不典型SCID免疫表型,例1有母体嵌合。二代测序提示,例1为复合杂合JAK3突变c.3097-1GA/c.946-950GCGGAACins GGT;例2、3、4为IL2RG突变,分别为c.865CT/p.R289X、c.664 CT/R 222 C、52 del G;例5为杂合JAK 3突变c.2150 AG/p.E 717 G、c.1915-2 AG。Sanger测序提示,例6为复合杂合的RAG1突变c.994CT/p.R332X、c.1439GA/p.S480N;例7为纯合的RAG1突变c.2095CT/p.R699W。结论 SCID基因突变在一定情况下可导致不典型的临床和/或免疫表现。     

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目的分析中国人群儿童尿道下裂患者5α-还原酶2型基因(SRD5A2)突变的发生率,探讨该疾病可能的分子机制。方法选择2006-01-01—2011-12-01上海交通大学医学院附属瑞金医院52例尿道下裂患儿,观察临床特征并行辅助检查,采用PCR直接测序方法对SRD5A2基因的1-5外显子进行测序分析。结果在52例患儿中共发现了包括4个突变位点的7例SRD5A2基因突变(突变率为13.5%),其中5例为复合杂合突变(p.G203S/p.R227Q,p.L20P/p.R227Q,p.L20P/p.R227Q,p.L20P/p.G203S,p.R227Q/p.R246Q),另2例为纯合突变(p.R227Q和p.L20P)。结论 SRD5A2基因突变可能为中国儿童尿道下裂的常见病因之一,对尿道下裂患儿应在性别决定和外科手术矫治前即行SRD5A2等基因的分子筛查,以期对本症更有效的防治。     

先天性类脂质性肾上腺皮质增生症临床特点及StAR基因突变分析

该文回顾性分析2例先天性类脂质性肾上腺皮质增生症(LCAH)患儿的临床表现、类固醇激素谱及影像学检查结果, 采用DNA直接测序法及限制性片段长度多态性(RFLP)技术对类固醇生成急性调节蛋白(StAR)基因突变进行分析。2例患儿均为46, XX女性, 确诊年龄分别为4个月及2岁4个月。婴儿早期出现皮肤色素沉着、生长迟缓、低钠血症等肾上腺皮质功能低下表现, 血ACTH显著增高, 皮质醇正常或降低, 各类雄性激素均未见增高。肾上腺超声提示双侧肾上腺增大或正常, 经氢化可的松及9α-氟氢可的松替代治疗后生长发育正常。StAR基因突变分析显示患儿1为p.Q258X纯合已知无义突变; 患儿2为p.E123K/IVS4+2T>A复合杂合突变, 且为新突变, 其父母分别为新突变IVS4+2T>A及p.E123K的携带者。保守性分析及PolyPhen-2软件预测提示p.E123K为致病性突变。RFLP分析显示患儿2及其父亲的PCR扩增产物经酶切后同时出现670、423、247 bp 3条条带, 而其母亲及50例正常对照仅出现423和247 bp两条条带, 提示IVS4+2T>A突变改变氨基酸酶切位点。对于婴儿早期发生的肾上腺皮质功能低下的女性表型患儿应警惕LCAH, 类固醇激素谱、核型分析及肾上腺超声有助诊断, 确诊依赖StAR基因突变分析。     

NF1基因突变致1型神经纤维瘤病8例临床分析

目的了解1型神经纤维瘤病(NF)的临床表型特征及异质性。方法回顾分析8例NF患儿的临床及基因检测资料。结果 8例患儿中男5例、女3例,均因生后多发牛奶咖啡斑就诊,2例伴丛状神经纤维瘤,1例伴多处皮肤神经纤维瘤。8例患儿有7种突变形式,NF1基因全部缺失2例;4种缺失突变,分别为c.4974_4977delCTAT,p.Y1659TfsX17、c.3987_3988delAG,p.S1329fsX4、c.1511delC,p.P504QfsX22和c.6388delC,p.L2130fsX3;1种c.3975-2delA剪切突变;1种c.3721 CT,p.R1241X无义突变。除全基因大片段缺失和无义突变之外,其余均为未报道的新突变。患儿父母外周血均未检测出相应的突变。结论 NF1基因突变可致1型NF,此研究发现5种新的突变,且均为de novo突变。多发牛奶咖啡斑是1型NF最早的临床表现,对疑似患者应尽早行基因分析确诊。     

先天性甲状腺功能减退症患儿GNAS和THRA基因突变分析

目的 对70例先天性甲状腺功能减退症（CH）患儿的刺激性G蛋白α亚基（GNAS）基因和甲状腺素受体α（THRA）基因进行二代测序分析,并初步探讨GNAS和THRA基因突变型与CH患儿的临床表现型之间的关系。方法 选取70例通过新生儿筛查确诊为CH的患儿,采集外周血并进行DNA样本提取,利用二代测序技术对GNAS和THRA基因进行突变筛查,利用生物信息学软件分析基因突变的致病性。结果 70例CH患儿中,3例患儿（4%）检出9种GNAS基因的错义突变（包括3种已知基因突变和6种新突变）,4例患儿检出同1种THRA基因多态c.508A > G（p.I170V）。经过生物信息学软件预测和ACMG/AMP指南分析发现2种GNAS基因突变[c.301C > T（p.R101C）、c.334G > A（p.E112K）]致病的可能性大。3例携带GNAS基因突变的患儿存在不同程度的甲状腺功能低下表现。结论 GNAS基因突变与CH的发病有关,患儿的临床表现存在较大的异质性;THRA基因突变可能与CH的发病无相关性。     

STXBP1基因突变致癫性脑病8例病例系列报告

目的 总结STXBP1基因突变所致的癫性脑病的临床表现及基因突变特点。方法 回顾性分析2011年12月30日至2018年1月31日于复旦大学附属儿科医院就诊且基因诊断为STXBP1基因突变的癫性脑病患儿的临床特点、基因检测结果、治疗和疗效。结果 8例STXBP1基因突变致癫性脑病患儿进入本文分析,男、女各4例,起病年龄为生后2 d至6月龄（中位数为生后15 d）。8例均存在发育落后,均有不同程度的反应欠佳、眼示踪较差,2例角弓反张,1例皮肤黝黑、阴囊着色较深。脑电图波形：4例为暴发抑制,3例为高峰失律,1例为两侧较多痫样放电。2例行DST（智力及发育筛查）,DQ（发育商）和MI（智商指数）均<50。1例合并先天性喉软骨发育不良,腹部B超示肾上腺皮质均质性增大。1例合并孤独症。8例共检测到7个STXBP1基因突变位点,其中错义突变4个,无义突变2个,移码突变1个。c.1216C>T (p.R406C)、c.246G>A（p.K82K）、c.1702G>A(p.G568S)和 c.54delG位点此前未被人类基因突变数据库(HGMD)收录,经软件预测均为有害突变;c.1439C>T（p.P480L）、c.585 C>G( p.Y195X)和c.1162C>T（p.R388X）为HGMD已收录的致病位点。4例诊断为大田原综合征,3例为WEST综合征,1例为不能分类的癫综合征。经过单药或联合治疗,5例得到临床发作控制,3例表现为药物难治性癫。结论 STXBP1基因突变相关的癫性脑病是严重的儿童神经系统疾病,肾上腺增大可能为其新的表型之一。     

疑似新生儿肝内胆汁淤积症SLC25A13基因突变检测分析

目的 建立SLC25A13基因突变分析方法,分析19例临床疑似新生儿肝内胆汁淤积症(NICCD)患儿SLCE25A13基因突变情况.方法 选取2004-2006年间在广州市儿童医院住院,临床表现为黄疸、肝功能异常、低血糖和(或)低蛋白血症,疑似NICCD的患儿19例,应用聚合酶链反应-DNA测序方法对其SLC25A13基因上14种已知突变进行检测分析.结果 19例患儿中8例患儿为SLC25A13基因纯合或杂合突变,6例为单个SLC25A13等位基因携带突变.共检测出两种突变类型.即851～854del(突变Ⅰ)和IVS6 5G>A(突变X).突变Ⅰ占86.4%(19/22),突变X占13.6%(3/22).结论 出现不明原因黄疽、肝功能异常、低血糖和(或)低蛋白血症患儿需高度警惕NICCD可能,应行相关基因突变分析以诊断和鉴别诊断.突变Ⅰ是本研究中NICCD患儿最常见的突变类型.聚合酶链反应-DNA测序是检测SLC25A13基因突变,诊断NICCD的有效可行方法.     

Two novel mutations in the human thyroid peroxidase (TPO) gene: genetics and clinical findings in four children

We report four children originating from two unrelated German families with congenital hypothyroidism (CH) due to mutations in the thyroid peroxidase (TPO) gene. Three female siblings (family 1) were found to be compound heterozygous for two mutations, a known mutation in exon 9 (W527C), and a mutation in exon 8 (Q446H), which has not been described before. In the second family we identified a boy with goitrous CH, who had a novel homozygous mutation in the TPO gene in exon 16 (W873X). All children of family 1 were diagnosed postnatally by newborn screening. The case of the boy of family 2 has already been reported for the in utero treatment of a goiter with hypothyroidism.
Conclusion: Our results confirm existing data on the phenotypic variability of patients with TPO gene mutations.     

Long-term clinical follow-up and molecular genetic findings in eight patients with triple A syndrome

The triple A syndrome (Allgrove syndrome, OMIM #231550) is caused by autosomal recessively inherited mutations in the AAAS gene on chromosome 12q13 encoding the nuclear pore protein ALADIN. This multisystemic disease is characterised by achalasia, alacrima, adrenal insufficiency and neurological impairment. We analyse long-term clinical follow-up and results of sequencing of the AAAS gene in eight patients with triple A syndrome aged from 2 to 35?years. At the time of diagnosis, all patients presented with alacrima, neurological dysfunction, dermatological abnormalities, seven of them with adrenal insufficiency and five of them with achalasia. Sequencing of the AAAS gene identified the p.S263P mutation in five of eight patients, supporting the hypothesis that this mutation is a founder mutation in Slavic population. One of the patients is homozygous for the p.S263P mutation, two are compound heterozygous for the p.S263P and the p.G14fs mutation, two are compound heterozygous for the p.S263Pro mutation and p.S296Y mutation, two are compound heterozygous for the p.G14fs and the p.Q387X mutations and one is homozygous for the p.Q387X mutation. In the course of the follow-up time of 4-29?years, progression of existing and appearance of new symptoms developed. Although severe, many of these symptoms presented in all six young adult patients are often overlooked or neglected: postural hypotension with blurred vision and syncope, hyposalivation resulting with complete edentulosis, talocrular contractures with permanent walking difficulties and erectile dysfunction in male patients. Triple A syndrome is a progressive debilitating disorder which may seriously affect quality of life and even be life-threatening in patients with severe neurological impairment. Conclusion: Long-term follow-up of patients with triple A syndrome revealed a variety of the clinical features involving many systems. Progressive natural course of the disease may seriously affect quality of life and even be life-threatening in patients with severe neurological impairment.     

甲状腺球蛋白增高的先天性甲状腺功能减退症1例报告并文献复习

目的 探讨甲状腺球蛋白(TG)增高的先天性甲状腺功能减退症(CH)家系的临床特征及TG基因变异特征.方法 回顾分析1个TG增高的CH家系的临床及TG基因检测结果,并复习相关国内外文献.结果 先证者,女,45日龄,生后黄疸消褪延迟伴便秘.甲状腺功能检测提示为CH,同时发现TG水平增高.基因检测结果显示患儿TG基因存在c....     

反复皮肤、巩膜黄染2年

患儿,女,2岁,反复皮肤、巩膜黄染2年,无其他症状及体征,应用苯巴比妥类药物黄疸可缓解。实验室检查间接胆红素多次升高,转氨酶正常,肝脏影像学正常,无溶血证据。患儿尿苷二磷酸葡萄糖醛酸转移酶(UGT1A1)基因分析提示:存在已报道的GS致病突变,c.211GA(G71R)、c.1456TG(Y486D)双重纯合突变;父母均为G71R、Y486D双重杂合携带者,无黄疸症状。确诊为Gilbert综合征(GS)。该病较少见。高未结合胆红素血症不能用常见肝损害及溶血解释时,建议调查家族史,尽早完善基因分析,以发现某些先天性胆红素代谢障碍性疾病。     

山东地区儿童先天性甲状腺功能减低症伴甲状腺发育不全TUBB1基因突变的研究

目的 探讨山东地区先天性甲状腺功能减低症（CH）伴甲状腺发育不全（TD）患儿TUBB1基因突变的类型和特点。方法 对山东地区289例确诊CH伴TD患儿进行TUBB1基因全编码区突变研究。提取患儿外周血全基因组DNA，PCR扩增TUBB1基因全编码区，对扩增产物进行Sanger测序，并进行生物信息学分析。结果 289例CH伴TD患儿中发现4例（1.4%） TUBB1基因存在c.952C > T （p.R318W）杂合变异，导致TUBB1蛋白第318位色氨酸变成精氨酸，根据美国医学遗传学与基因组学学会遗传变异分类标准与指南，该变异评级为"可能致病的"。结论 在山东地区CH伴TD患儿中发现了新的TUBB1基因变异，提示TUBB1基因可能是CH伴TD的候选致病基因。     

Pendred syndrome among patients with congenital hypothyroidism detected by neonatalscreening: identification of two novel <Emphasis Type="Italic">PDS/SLC26A4</Emphasis> mutations

Pendred syndrome is an autosomal recessive disorder characterised by sensorineural hearing loss and thyroid dyshormonogenesis. It is caused by mutations in the PDS/SLC26A4 gene (OMIM 605646) encoding for pendrin. Hypothyroidism in Pendred syndrome can be—although rarely—present from birth and therefore diagnosed by neonatal screening. The aim of our study was to identify patients with Pendred syndrome among a historical cohort of patients with congenital hypothyroidism (CH) identified by neonatal screening, and to find their mutations in the PDS/SLC26A4 gene. We investigated 197 Czech Caucasian children with CH detected by the neonatal screening between the years 1985 and 2005. The clinical diagnosis of Pendred syndrome was based on the laboratory and sonographic signs of thyroid dyshormonogenesis in association with sensorineural hearing loss. In subjects clinically diagnosed with Pendred syndrome, we sequenced all exons and exon-intron boundaries of the PDS/SLC26A4 gene. Hearing loss was present in 10/197 children with screening-detected CH. Of these, three fulfilled the diagnostic criteria of Pendred syndrome. Two patients were compound heterozygotes for PDS/SLC26A4 mutations: patient 1 carried c.2089+1G>A / c.3G>C and patient 2 carried p.Tyr530His / p.Val422Asp. Two of the four identified mutations were novel (c.3G>C in patient 1 and p.Val422Asp in patient 2). The third patient was free of mutations in the PDS/SLC26A4 gene, representing a phenocopy. In conclusion, our results indicate the rarity of Pendred syndrome as a cause of CH. The identification of two novel mutations expands the spectrum of mutations in the PDS/SLC26A4 gene and emphasizes their marked allelic heterogeneity. The study was supported by grants of the Czech Ministry of Education (MSM 0021620814) and Charles University in Prague (GAUK 2008/2007).     

Genetic Analysis in Children with Transient Thyroid Dysfunction or Subclinical Hypothyroidism Detected on Neonatal Screening

About 30% of children with elevated TSH levels during neonatal screening have a transient form of disorder. On the other hand, it has been reported that subclinical hypothyroidism persists in late childhood in about 30% of children found to be false-positive during neonatal screening. The aim of this study was to determine whether transient thyroid dysfunction and subclinical hypothyroidism detected during neonatal screening are influenced by genetic background. The TSH receptor (TSHR), thyroid peroxidase (TPO) and dual oxidase 2 (DUOX2) genes, for which it has been reported that heterozygous defects cause neonatal transient thyroid dysfunction, were analyzed. Nine children with transient thyroid dysfunction or subclinical hypothyroidism detected during neonatal screening were studied. One child was heterozygous for a TSHR gene mutation (R450H), and another child was heterozygous for a TPO gene mutation (P883S). No children with mutation of the DUOX2 gene were identified. Genetic background may contribute to development of transient thyroid dysfunction and subclinical hypothyroidism detected during neonatal screening.     

HDAC8基因变异所致Cornelia de Lange综合征1例报告

目的探讨Cornelia de Lange综合征(CdLS)的临床表型及基因型特点。方法回顾分析1例确诊CdLS患儿的临床资料,并总结分析国内已报道病例的情况。结果女性患儿,1岁2月龄,有特殊外貌,智力及运动发育落后,合并四肢畸形及听力异常。基因检测发现患儿HDAC8基因c.675C>A(p.Y 225X)存在新发杂合无义变异,根据ACMG指南预测为致病性变异,确诊CdLS。通过对万方、维普、中国知网及PubMed数据库搜索,发现国内报道CdLS病例46例。其中26例行基因检查,20例(76.9%)存在NIPBL基因变异,3例(11.5%)HDAC8基因变异,1例(3.8%)SCM1A基因变异,2例未发现与临床吻合的致病性基因变异,表型各异。结论CdLS患儿存在特殊外貌、生长发育迟缓、多器官受累、听力障碍,多数可通过典型临床表型诊断,基因检测有助于非典型患者的早期诊断。     

High prevalence of congenital hypothyroidism in the Greek Cypriot population: results of the neonatal screening program 1990-2000

OBJECTIVE: To evaluate the results of the screening program for congenital hypothyroidism (CH) in the Greek Cypriot population. CHILDREN AND METHODS: During 1990-2000, 109,532 neonates were screened by TSH determination. Permanent CH was proven with biochemical findings after discontinuation of treatment for scintigraphy at the age of 3 years. RESULTS: Permanent CH was diagnosed in 61 infants, incidence 1/1800, with female/male ratio 2.05/1. The most common clinical findings were omphalocele (61%), large anterior fontanelles (49%) and edema of the eyelids (34%). The more delayed the bone maturation, the lower were initial T4 levels (p = 0.005). Bone maturation tended to be more advanced in thyroid hypoplasia and more delayed in thyroid agenesis (p = 0.049). Scintigraphy of the thyroid with TC99 revealed ectopia in 38%, thyroid agenesis in 36%, thyroid hypoplasia in 24% and dyshormonogenesis in 1.7%. Children with transient CH had significantly lower T4 and higher TSH values initially compared to those with permanent CH after birth; initial TSH level, however, failed to predict the nature of CH. Children with transient CH required less thyroxine dosage to maintain normal thyroid hormone levels and they had a normal thyroid gland on scintigraphy. The TSH level was normalized before the age of 2 months with a starting L-thyroxine dose of 10 microg/kg/daily. CONCLUSIONS: The incidence of primary CH in Greek Cypriots is 1/1800 live births. The most common etiology is thyroid dysgenesis. Initial T4 levels correlated with the degree of skeletal maturation and the etiology. Initial TSH level, although lower in children with transient CH, could not predict the nature of CH.     

NPHS1基因Fin-minor突变致中国先天性肾病综合征2例报道并文献复习

目的总结2例先天性肾病综合征芬兰型NPHS1基因Fin-minor突变患儿临床资料,提高对该病的认识。方法报道2例先天性肾病综合征患儿的临床特点。对可能致病基因NPHS1、NPHS2、PLCε1、LAMB2、COQ2和LMX1B外显子和WT1基因第8、9外显子,以及外显子相邻附近区域进行直接测序。对该家系相关成员进行NPHS1基因外显子及附近调控区域直接测序,分析突变位点,并文献综述。 结果2例患儿均于出生后1个月内起病,临床表现为肾病综合征。血清病原学检查均为阴性。家系调查未发现家族中有类似疾病的成员。NPHS1、NPHS2、PLCε1、LAMB2、COQ2、LMX1B和WT1基因分析发现,2例患儿存在双NPHS1基因杂合突变,未发现其他基因有致病性突变。1例患儿为NPHS1基因的p.R1109X（c. 3325C>T ,Fin-minor）和IVS26DS-2A>T杂合突变,IVS26DS-2A>T剪切突变为首次报道,其父亲携带IVS26DS-2A>T,其母亲携带p.R1109X。1例患儿为NPHS1基因的p.R1109X （c. 3325C>T ）和p.A1160X （c.3478C>T）杂合突变,其母亲携带p.R1109X突变,未发现p.A1160X突变,其父亲拒绝行NPHS1基因分析。以上发现的突变在100例正常人群中未发现。 结论中国先天性肾病综合征儿童不仅有NPHS1基因突变,而且有经典的Fin-minor突变,为国内首报。本研究新发现的IVS26DS-2A>T剪切突变丰富了NPHS1基因突变谱。