非综合征型唇腭裂病因学研究进展

非综合征型唇腭裂是人类最常见的结构性出生缺陷,对患儿、家庭和社会均造成沉重负担。由于致病机制复杂,到目前为止病因尚未完全阐明。全基因组关联研究有效地发现了多个新的易感基因位点,但由于GWAS只对常见SNPs进行研究,未检测罕见变异与疾病的关联,且未考虑基因的生物学功能,因此并不能完全解释疾病的遗传度。通路分析和外显子组测序研究能够在一定程度上弥补全基因组关联研究的不足,有望为解决复杂疾病的病因学问题提供有效方案。     

非综合征型唇腭裂二代测序研究进展

非综合征型唇腭裂（NSOC）是一种常见的出生缺陷。中国活产儿NSOC患病率为1.13/1 000活产儿～1.30/1 000活产儿,高于其他种族人群。NSOC是受基因和环境因素共同作用的复杂疾病,虽然全基因组关联研究发现了NSOC的多个遗传致病位点,但目前发现的遗传位点只能解释NSOC一小部分遗传度,未被解释的遗传度可能来自罕见遗传变异、拷贝数变异以及交互作用等。二代测序研究为进一步探索NSOC遗传危险因素提供了新的方法和思路,本文将对NSOC二代测序研究进行综述。     

新疆维、汉族非综合征型唇腭裂危险因素分析

目的 调查新疆维吾尔族、汉族非综合征型唇腭裂(NSCL/P)可疑危险因素,分析维、汉族危险因素异同点并提出有效预防措施.方法 采用病例-对照研究方法,收集新疆维吾尔族、汉族NSCL/P病例、对照共290例,进行危险因素单因素、多因素logistic回归分析.结果 维吾尔族NSCL/P病例-对照研究中,性别(P< 0.05)、母亲平时健康情况(P< 0.05)、孕期有无感冒(P< 0.05)差异有统计学意义;汉族NSCL/P病例-对照研究中,父亲文化程度(P< 0.05)、母亲孕早期工作强度(P< 0.05)、父亲是否饮酒(P< 0.05)差异有统计学意义.结论 维吾尔族和汉族NSCL/P危险因素存在民族差异;性别为男、母亲孕期健康差、母亲孕期感冒是维吾尔族NSCL/P的可能危险因素;父亲文化程度低、母亲孕早期工作过度、父亲饮酒是汉族NSCL/P的可能危险因素.     

非综合征性唇腭裂基因环境交互作用研究进展

非综合征性唇腭裂(NSCL/P)是一种多基因易感性疾病,环境因素和遗传因素的交互作用对NSCL/P发生的影响是理解该病发病机制的关键之一.近年来,陆续出现环境因素和遗传因素交互作用对唇腭裂发生的影响研究,所涉及的因素主要有母亲吸烟、饮酒、孕期维生素补充、家族史、种族、孕期药物使用等环境因素以及TGFα、TGFβ3、TGFβ2,MSX1、CYP1A1、GST、NAT、MTHFR、BCL3、RARA、EPHX1等基因.本文分别从环境-基因和基因-基因交互作用两方面的研究概况做一综述.     

空卵泡综合征的病因学研究进展

空卵泡综合征(EFS)的发病机制目前尚不明确，但由于其关系到患者未来的治疗前景，已引起人们足够的重视。总结近二十年国外关于EFS发生的病因学研究成果，对其发病机制从药物源性、卵巢源性、遗传和基因突变、取卵技术4个方面做一扼要综述。     

非综合征型唇腭裂易感基因多态性研究进展

非综合征型唇裂伴或不伴腭裂(nonsyndromic cleft lip with or without cleft palate,NSCL/P;简称为非综合征型唇腭裂)是指不伴发其他系统畸形的不属任何综合征的唇裂、唇裂合并腭裂的总称,这是一种常见的颌面部先天畸形[1].文献报道NSCI/P发病率为1/700 [2],不同种族和地域发病率有很大差异,其中亚洲黄种人最高、欧洲白种人次之、非洲黑种人最低.在我国NSCL/P发病率高居出生缺陷前列,远远高于世界平均水平.NSCL/P不仅造成患者面部畸形,而且还影响患者的语言、听力,甚至会影响患者的心理健康,给患者的家庭和社会都带来了严重的负担.而NSCI/P的治疗又是一个多学科联合的过程,尽管如此,大部分NSCL/P病例都不能完全治愈.因此寻找该病的病因,进而找到有效的预防手段显得非常重要.     

1988—1992年中国非综合征性唇腭裂发生率的动态变化

目的：了解我国1988－1992年非综合征性唇腭裂发生率的动态变化趋势及流行病学特征。方法：在1988－1992年期间,采用以医院为单位的整群抽样方法,对全国500多所医院孕28周至产后7天的4349例非综合征性唇腭裂病例进行回顾性分析。结果：我国5年非综合征性唇腭裂发生率无显著性差异,城乡发生率也无显著性差异。男性发生率为14．9／万,女性发生率为11．7/万,差异有显著性,非综合征性唇腭裂的性别比为1．3：1。三类非综合征性唇腭裂各自的发生率为：唇裂合并腭裂：7．8／万,单纯性唇裂：3．8／万,单纯性腭裂：1．8/万。结论：我国非综合征性唇腭裂发生率无变化趋势,城乡无差异。男性高于女性,唇裂合并腭裂为最常见类型。     

非综合征性唇腭裂环境危险因素病例对照研究

目的分析非综合征性唇腭裂(nsCL/P)与孕早期环境暴露因素之间的关系。方法选择在贵阳医学院附属医院和广西百色市人民医院就诊的212例nsCL/P患者作为病例组,221例外伤病人和骨折病人作为对照组。采用自行设计的调查表,通过面对面询问433例研究对象的父母亲获取问卷资料,运用单因素及多因素非条件Logis-tic回归模型分析环境危险因素与非综合征性唇腭裂的关联性。结果病例组父亲和母亲具有高中及以上文化程度的比例(37.7%,27.4%)明显低于对照组(60.6%,57.0%);病例组父亲和母亲为农民的比例(77.4%,77.8%)明显高于对照组(52.5%,52.5%);在调整了父母的文化程度和职业分布影响后,多因素分析结果显示,母亲孕早期被动吸烟(OR=1.643)、母亲孕早期感染史(OR=2.741)、父亲知晓怀孕前饮酒(OR=1.793)明显增加nsCL/P的发病风险。结论怀孕夫妇在孕早期应避免烟酒等不良嗜好并注意防止感染的发生,以减少后代患唇腭裂的风险。     

200例非综合征性唇腭裂危险因素调查

目的 探讨非综合征性唇腭裂发病的危险因素.方法 以非综合征性唇腭裂患儿为病例组,另设对照组进行病例对照研究.结果 非综合征性唇腭裂的发生在不同孕母年龄和不同孕母学历、不同职业间差异有统计学意义(P＜0.05),多因素logistic回归分析显示母亲学历低、孕早期饮酒、被动吸烟、孕早期精神压力大和家族史是非综合征性唇腭裂发病的危险因素,孕早期补充叶酸是保护因素(P＜0.05).结论 影响非综合征性唇腭裂发生的因素较多,需采取综合性的预防控制措施.     

非综合征型单纯腭裂遗传流行病学研究进展

单纯腭裂是一种较为常见的出生缺陷,其中非综合征型单纯腭裂（NSCPO）占50%。NSCPO是受遗传和环境共同作用的复杂疾病,与非综合征型唇裂伴或不伴腭裂（NSCL/P）不同,通过全基因组关联研究发现的与NSCPO相关的常见遗传变异相对较少。本文对NSCPO的遗传流行病学研究进展进行综述。根据现有研究证据将已发现的NSC...     

Environment and genetics in the etiology of cleft lip and cleft palate with reference to the role of folic acid

The combined birth prevalence of cleft palate [CP] and cleft lip with or without cleft palate [CL(P)] in Europe is approximately one in 700 with characteristic regional variations. Orofacial clefting (OC) is therefore now one of the most frequent congenital anomalies, with a higher birth prevalence that Down's Syndrome or Neural Tube defects, but still lower than cardiovascular malformation. Babies with OC require a multidisciplinary medical approach, surgery and rehabilitative treatments over time. This means an important effort in terms of social organization as well as economical costs for the health care system. In Italy, the health care costs for approximately 800 children born with orofacial clefting per year has been estimated at around 150 billion Lire (80 million Euros). The etiology of OC is complex and heterogeneous both for isolated and associated defects; causes linked to environment, genetics and gene-environment interaction are known, although there is still a lot to do, especially in clarifying the role of genetics in producing susceptibility to the environment. Four categories of genes for which there are results suggestive of a genetic susceptibility to OCs are: 1) genes expressed in a particular area of the embryo or in a particular period of the palatine arch development, such as the transforming growth factors alpha and beta (TGF alpha, TGF beta 2, TGF beta 3); 2) genes having biological activities linked to the OC's pathogenesis without direct involvement (e.g. the retinoic acid receptor (RARA), the methylenetetrahydrofolate reductase receptor (MTHFR) and the folic acid receptor (FOLR1); 3) genes or locus identified in experimental animals as the homeotic genes MSX-1 and MSX-2; 4) genes involved in the interaction with the xenobiotics metabolism as those in P-450 cytochrome system. Several environmental factors have been implicated in the OC etiology; among those, the folic acid supplementation during the periconceptional period that was found effective in the prevention of neural tube defects. In fact, folic acid deficiency may be responsible for different malformations through a common mechanism that interferes with the embryonic development, depending on the maternal or embryo genotype. Further investigation is required to study in depth how the genotype would modify the role of environmental factors like folic acid. Well-designed and conducted epidemiological studies seem to be able to give worthwhile information. Studies carried out in Europe on these issues are a few, particularly those on gene-environment interaction. Recent results obtained in molecular biology and the availability of wealth of data can allow to perform ad hoc investigations, being important not only for the basic research but also for their public health implications. For this objective a specific scientific network at the European level has been set by the European Science Foundation (ESF), whose first step will be to establish consistent case ascertainment and data collection across Europe and to develop standardized protocols and methods of analysis. It is hoped that in the longer term such multicentre collaborative research will enable combined analysis and lead to the identification of genetic susceptibility to certain environmental factors, including nutrition. Such studies would inform the current debate about the efficacy of folic acid and other nutritional factors in prevention of disease in the developing embryo. Subsequent public health measures targeted according to risk might reduce the prevalence of disorders such as orofacial clefting.     

中国人群WNT代谢通路与非综合征型唇腭裂的亲源效应分析

目的 非综合征型唇裂合并或不合并腭裂（NSCL/P）是一类常见的出生缺陷,遗传致病因素一直是其病因学研究的热点。本研究拟基于家系设计在WNT代谢通路基因中探索亲源效应对NSCL/P发病风险的影响。方法 本研究人群为“唇腭裂的基因组学国际合作组研究”项目在中国地区募集的806个NSCL/P核心家系。利用对数线性模型探索WNT基因及其单体型的亲源效应与疾病的关联,采用Wald检验探索亲源效应与环境因素的交互作用。经过Bonferroni多重检验校正后,统计学检验的显著性阈值设为P<3.47×10^-4。结果 质量控制后共纳入7个基因上144个单核苷酸多态性位点进行分析。结果显示,NSCL/P家系中有8个位点具有潜在的亲源效应（P<0.05）,但经Bonferroni多重检验校正后,均未达到统计学显著性水平（P>3.47×10^-4）。NSCL/P家系中位于WNT9A rs4074668-rs12725747单体型（T-A）具有亲源效应,且经Bonferroni校正后差异仍有统计学意义（P=2.74×10^-4）。但该单体型的亲源效应与环境因素（被动吸烟、复合维生素补充）的交互作用并未达到统计学显著水平。结论 WNT代谢通路基因可能通过亲源效应影响NSCL/P的发生风险。位于WNT9A基因rs4074668-rs12725747单体型（T-A）亲源效应与NSCL/P发病风险存在显著关联。未来仍需其他独立样本验证以进一步确认WNT代谢通路在NSCL/P发生中的作用。     

Nutrition of children with cleft lip and cleft palate, a bibliographic study

The present study aimed at describing the children with congenital lip-palate malformation, emphasizing their alimentation, such as the difficulties and alternative methods to feed these children and nursing care in this process. The bibliographic review showed that there are many aspects in the alimentation care to fissured children, involving complex affective, social, economic and cultural relations that influence in mother-child relationship, in social discrimination of the fissured children and in mothers' difficulty to feed and give care to the child. Authors found the need to implement breast feeding, pointing out the physiological, psychological and social limitations that involve the child and the family as well as the importance of alimentation to physical and emotional development, favouring the surgical correction of lips and/or palate fissures as well as the rehabilitation process.     

骨形成蛋白4基因与NOG基因的交互作用与非综合征性唇腭裂的关系

目的:探讨骨形成蛋白4基因538T/C(BMP4 538T/C)变异与NOG基因615G/C(NOG 615G/C)变异之间交互作用在非综合征性唇腭裂(nsCL/P)发生中的意义。方法:从两家综合性医院中选择200名nsCL/P患者和200名对照,两组在年龄、性别、家庭社会经济状况方面相匹配。应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测BMP4538T/C、NOG 615G/C的多态性;运用相加模型分析BMP4 538T/C与NOG 615G/C变异之间的交互作用。结果:用非条件Logis-tic回归模型调整父母亲怀孕时的年龄和文化程度后,BMP4 538T/C与NOG 615G/C变异之间对nsCL/P患病具有正交互作用,归因交互效应2.05,归因交互效应百分比46.28%,纯因子间归因交互效应百分比59.77%,交互效应指数2.49。结论:BMP4538T/C与NOG 615G/C变异之间交互作用在该研究人群nsCL/P患病中具有重要意义。     

非综合征性唇腭裂部分基因SNPs研究进展

非综合征性唇裂伴或不伴腭裂是人类最常见的先天性畸形之一,是一种遗传、环境因素及两者相互作用所致的多基因多因素遗传疾病.单核苷酸多态性是新一代遗传标记,可被用来寻找各种致病基因,目前认为单核苷酸多态性及其特定组合可能是造成以多基因多因素遗传病为代表的复杂性状疾病易感性的重要原因.     

Genetic epidemiology of cleft lip with or without cleft palate in the population of Hawaii

Orientals consisting of Japanese, Chinese, Koreans, and Filipinos are clearly at higher risk for cleft lip with or without cleft palate [CL(P)] than whites, Puerto Ricans, and Hawaiians/part-Hawaiians in Hawaii. Using the model of diallele cross, CL(P) incidences in incrosses and outcrosses involving 564,002 live births distributed among 669 mating types were analyzed to study the extent of major gene involvement in the difference in the two groups and to investigate maternal effect in the etiology of CL(P). CL(P) cases excluding syndrome cases were classified into two types: all CL(P) cases and CL(P) cases without additional malformations. For either type there was no evidence to suggest that simple major gene plays a dominant role in accounting for racial differences as measured by deviations from additivity in the hybrids. For CL(P) cases without additional defects, a negative "maternal effect" was detected in Filipinos such that higher risk for this racial group depends on when the father is Filipino. Implications of the findings are discussed.