致死性家族性失眠症的临床特点及脚基因突变分析

目的：探讨中国致死性家族性失眠症（FFI）患者的临床及PRNP基因突变特点。方法：对一个FFI家系进行调查并综合分析先证者的临床资料;应用PCR技术结合DNA直接测序方法对先证者进行PRNP基因的突变筛查,回顾分析中国已报道的FFI先证者的临床特点。结果：在该先证者检出朋^垆基因2号外显子上的c．532G〉A（p．D178N）突变及c．385AA（p．129MM）多态,据此可确诊为FFI。Meta分析提示中国FFI患者的临床表现均较典型,PRNP基因单体型均为D178N-129MM。结论：尽管FFI患者的临床表现较典型,但对临床上疑为FFI的患者,仍应进行艄ⅣP基因突变筛查以助确诊。     

致死性家族性失眠症一例临床及基因特征

目的研究及报道1例致死性家族性失眠症(fatalfamilial insomnia,FFI)的临床及人类朊蛋白(human prion protein,PrP)基因特征。方法分析了1例疑为FFI患者的临床特征,采集血样后抽提DNA,应用聚合酶链反应(PCR)方法结合DNA测序技术,分析患者PrP基因突变。结果根据患者临床表现及PrP基因检测结果(PrP基因532G→A:D178N突变,129基因型为MM)诊断FFI。结论该患者特征性的呼吸困难和内环境紊乱值得重视,PrP基因检测对于确立FFI的诊断具有极其重要的作用,该FFI患者的发现,具有较大的临床和科研意义。     

致死性家族性失眠症一例的临床、病理及基因特征

目的 研究致死性家族性失眠症(fatal familial insomnia,FFI)患者的临床、病理及基因特征,并复习相关文献.方法 分析1例FFI患者的临床特点,对死亡患者进行尸检和脑组织病理检查,并对患者及其家属血标本进行朊蛋白基因(PRNP)检测.结果 该例患者的主要临床特征包括顽固性失眠、精神和夜间睡眠行为异常、行走不稳、吞咽困难、突然死亡以及阳性家族史.患者多处脑组织神经元丢失及胶质细胞增生,以丘脑为重;患者及其1名亲属PRNP检测分析显示D178N基因突变,并与129位甲硫氨酸等位基因连锁.结论 FFI患者可表现为猝死,可有突出的精神症状;无症状携带者可出现相应基因突变;提供尸检和脑组织病理资料有助于进一步认识本病.     

2例致死性家族性失眠症的临床特点、脑影像和朊蛋白基因分析

目的 探讨致死性家族性失眠症(fatal familial insomnia,FFI)的临床和生物学特征.方法 总结2例FFI患者的临床表现、治疗与转归特点,并追踪至死亡;对患者进行了较详细的生物学检查,包括生化、电生理、头颅MRI和PET-CT检查及朊蛋白(Prion Protein,PrP)基因测序.结果 2例FFI患者的共性:阳性家族史,临床主要表现睡眠紊乱伴精神、行为异常;影像检查示全脑轻度萎缩(额叶略明显),对称性顶、额叶及丘脑葡萄糖代谢降低;PrP基因532位碱基G突变为A和129MM纯合子变异.例1病情进展相对缓慢,死亡时总病程3年余,以运动系统损害突出,脑脊液14-3-3蛋白阴性;例2的病情进展迅速,死亡时总病程仅半年,以内分泌功能障碍突出,脑脊液14-3-3蛋白阳性,PrP基因173位碱基T-C变异.结论 2例FFI患者临床特点存在差异,可能与PrP基因突变及脑脊液14-3-3蛋白检测结果有关,有待进一步证实.     

致死性家族性失眠症患者一例报告并文献复习

目的 总结致死性家族性失眠症(fatal familiar insomnia,FFI)患者的临床表现和实验室检查的特点.方法 分析1例FFI患者的临床表现、影像学、脑电图及基因等资料,并结合文献进行复习.结果 患者为57岁女性,主要表现为入睡困难,睡眠过程中出现吸气性喉鸣,随后出现反应迟钝、低热、多汗等表现.患者头磁共振DWI序列未出现异常高信号,脑电图监测显示睡眠图消失,无三相波,朊蛋白基因检测显示为D178N-129MM的单倍体型,脑脊液14-3-3蛋白为阴性.结论 朊蛋白基因检测在诊断FFI中具有决定性作用.     

家族性致死性失眠症的临床和睡眠多导图特征

目的报道1例经基因检查结果证实的家族性致死性失眠症(FFI)家系2例患者的临床表现、影像学检查、睡眠多导图(PSG)检查。方法对于来自于同一个家系的2例中老年亚急性进行性痴呆患者进行临床和神经心理检查,行腰穿、头颅MRI、脑血流灌注、脑电图、PSG以及PRNP基因等检查。结果(1)该家系2代中共有4位患者,先证者和其妹妹先后发病,发病年龄分别为62岁和60岁,主要表现为失眠、睡眠相关喉鸣和不自主运动,快速进展性痴呆以及自主神经障碍。自发病至去世病程分别为10个月和11个月;(2)基因检查显示20号染色体PRNP基因出现D178N突变,129位氨基酸为M/M型;(3)PSG示睡眠效率减低,睡眠结构异常,I期睡眠减少,II期睡眠比例减少,REM睡眠缺如,阻塞性呼吸暂停事件,最低血氧饱和度为83%;(4)头颅MRI基本正常;(5)PET脑血流灌注显像,双侧中下额叶葡萄糖代谢率降低,左侧丘脑前下部葡萄糖代谢率减低。结论 FFI表现为顽固性失眠及睡眠相关障碍、快速进展性痴呆以及自主神经障碍。PSG和PRNP基因检查有助于FFI诊断。     

以姿势平衡障碍为突出表现的家族性致死性失眠一例并文献复习

目的报道1例以姿势平衡障碍为突出表现的家族性致死性失眠(fatal familial insomnia,FFI)患者的临床表现和基因特点。方法分析1例以姿势平衡障碍、重复语言为突出表现,曾疑诊为进行性核上性麻痹(progressive supranuclear palsy,PSP)的FFI患者的临床特征、影像学特点、脑电图及多导睡眠监测等资料,并对患者血标本进行朊蛋白PRNP基因检测。结果本例患者为39岁女性,症状逐渐进展,主要表现为姿势平衡障碍、语速快、重复语言,快速进展的认知障碍,伴睡眠相关呼吸暂停、吸气性喘鸣,同时有血压高、出汗多、心动过速、呼吸不规律等自主神经症状。结合患者PRNP基因检测结果为D178N/129M型,最终诊断为FFI。结论吸气性喘鸣或"牛吼声"在FFI的诊断中有提示意义。姿势平衡障碍在FFI临床症状谱中相对罕见,129位氨基酸等位基因多态性为Met/Met纯合子的FFI患者早期以姿势不稳,向后倾倒为主要临床表现的FFI病例,国内鲜有报道。     

中国华东地区家族性肌萎缩侧索硬化症患者SOD1基因突变检测及临床特点分析

目的对中国华东地区26例临床确诊为家族性肌萎缩侧索硬化症(FALS)家系的先证者进行铜锌超氧化物歧化酶(SOD1)的基因突变筛查。方法收集26例FALS家系先证者的外周血样本及临床资料。采用PCR技术结合DNA直接测序法对外周血DNA进行SOD1基因5个外显子的突变筛查,并分析SOD1基因突变与临床表型的关系。结果有6例先证者检测出3种SOD1突变。其中3例为位于2号外显子的已知错义突变p.His46Arg(c.140AG),均表现为单侧下肢远端起病,上运动神经元损害不明显,平均病程可达10年以上。2例为位于2号外显子的已知错义突变p.Val47Ala(c.143TC),临床表型较复杂,病变进展相对较快。1例为位于2号外显子新的错义突变p.Gly37Arg(c.112GC),单侧上肢远端起病,上下运动神经元均受损,进展缓慢。结论中国华东地区FALS患者中SOD1基因突变仍占首位,突变与临床表型相关,其中His46Arg的临床表型具有特征性,有助于疾病预后判断。     

脑腱性黄色瘤病的临床特征与基因突变分析

目的 分析脑腱性黄色瘤病( cerebrotendinous xanthomatosis,CTX)的临床表现、实验室检查特点、影像学特征及甾醇-27羟化酶基因(CYP27A1)突变,旨在提高对此病的认识,以利早期诊断和治疗.方法 对1例临床诊断为CTX的家系行CYP27A1基因突变分析,收集先证者的临床资料,进行为期8个月的随访,并结合文献对CTX的疾病特征进行分析.结果 患者为36岁男性,神经系统损害主要表现为智能低下,双侧皮质脊髓束、皮质脑干束受损表现,以及小脑及周围神经病变的表现；头颅MRI提示双侧基底节对称异常信号,小脑齿状核软化及钙化灶；跟腱MRI提示跟腱显著增粗；基因突变分析发现先证者存在CYP27A1基因5号外显子第1016位核苷酸C→T纯合突变,而先证者母亲与姐姐分别存在该基因第1016位核苷酸C→T杂合突变,为携带者.先证者予熊去氧胆酸治疗,随访8个月,患者前6个月规律服药,病情稳定,近2个月自行停药,病情加重.结论 CYP27A1基因5号外显子第1016位核苷酸存在C→T纯合突变(p.T339M)导致该患者发生CTX,符合常染色体隐性遗传特点.CTX临床表现具有一定的特征性,如跟腱增粗、智能减退、共济失调等,但早期影像学检查缺乏特异性,易被延误诊治.CYP27A1基因突变检测对早期诊断CTX具有重要意义,应予以重视,而早期应用鹅去氧胆酸治疗能延缓疾病进展.     

遗传性朊蛋白病一家系的临床、病理和基因突变分析

目的报道常染色体显性遗传家族性朊蛋白病一家系的基因突变，并分析先证者的临床表现、神经影像和脑活体组织检查病理改变。方法收集一个家族性痴呆家系中先证者的病史、临床表现、视频脑电图、头颅CT和头颅MRI资料；先证者在知情同意下经立体定向行脑活体组织检查术，取右额叶皮质，观察HE染色和免疫组织化学改变；提取外周血白细胞DNA，PCR直接测序，分析先证者和家族部分成员的朊蛋白基因（PRNP）异常，以150名健康志愿者为对照组检验该基因异常是否为单核苷酸多态性。结果先证者的临床表现、神经影像、脑电图和脑活体组织检查病理符合朊蛋白病诊断；先证者和部分家族成员检测出PRNP基因G114V错义突变，129密码子均为甲硫氨酸／甲硫氨酸（M／M）基因型；150名健康志愿者不具有G114V突变。结论我们发现了一个常染色体显性遗传的家族性朊蛋白病的PRNP基因G114V突变，可能为病理突变。     

家族性致死性失眠症临床及相关特征(附1例报道)

目的研究1例家族性致死性失眠症(Familial Fatal Insomnia,FFI)的临床及相关特征。方法分析家族性致死性失眠症患者的临床特征、动态脑电图正电子发射计算机断层扫描及基因测序等相关检查结果。结果朊蛋白基因分析基因D178N突变,并与129Met等位基因连锁;动态脑电图检查未见睡梭波出现,慢波睡眠明显减少;正电子发射计算机断层扫描显示丘脑代谢明显降低。结论家族性致死性失眠症具有特征性的临床、基因学、动态脑电图及正电子发射计算机断层扫描影像学改变。     

A novel mutation (G114V) in the prion protein gene in a family with inherited prion disease

Inherited prion diseases are characterized by mutations in the PRNP gene encoding the prion protein (PrP). We report a novel missense mutation in the PRNP gene (resulting in a G114V mutation in PrP) in members of a Uruguayan family with clinical and histopathologic features of prion disease. Affected individuals were characterized by an early age at onset, initial neuropsychiatric symptoms, late dementia with prominent pyramidal and extrapyramidal symptoms, and long disease duration.     

A subtype of sporadic prion disease mimicking fatal familial insomnia.

OBJECTIVE: To establish a variant of sporadic prion disease as the sporadic form of fatal familial insomnia (FFI). BACKGROUND: FFI is a recently described prion disease characterized clinically by severe sleep impairment, dysautonomia, and motor signs, and pathologically by atrophy of thalamic nuclei, especially the medial dorsal and anterior ventral, and of the inferior olive. FFI is linked to the D178N mutation coupled with the methionine codon at position 129 in the prion protein gene (PRNP). It is also identified by the properties of the abnormal prion protein (PrP(Sc)), which has the relative molecular mass of 19 kDa, corresponding to the so-called type 2, and a marked underrepresentation of the unglycosylated form relative to the diglycosylated and monoglycosylated forms. METHODS: Clinical, pathologic, PrP(Sc), and PRNP data from 5 subjects with a sporadic prion disease phenotypically similar to FFI were collected and analyzed. RESULTS: All 5 subjects had a disease clinically similar and histopathologically virtually identical to FFI. PrP(Sc) type 2 was present in all subjects in amount and distribution similar to those of FFI. However, the PrP(Sc) did not show the striking underrepresentation of the unglycosylated isoform of the protein that is characteristic of FFI. Moreover, none of the subjects had the D178N PRNP mutation but all were homozygous for methionine at codon 129. CONCLUSION: This condition is likely to represent the sporadic form of FFI and the term "sporadic fatal insomnia" is proposed.     

Fatal familial insomnia--a rare differential diagnosis in dementia

Fatal familial insomnia (FFI)--first reported in 1986--is a hereditary prion disease with autosomal-dominant inheritance, caused by a missense-mutation at codon 178 of the prion-protein gene (PRNP) on chromosome 20. A methionine-valine polymorphism at codon 129 of PRNP expresses different phenotypes. The clinical features of FFI are characterized by a disrupted sleep-wake cycle with resulting fluctuations of vigilance, autonomic hyperactivation, myoclonus, motor abnormalities and by cognitive disturbances. The age of onset is between middle to late adulthood (51 +/- 7.1 years), disease duration varies between 8 and 72 months (18.4 +/- 17.3 months) and is ultimately fatal. We report the case of a 57-year-old man with a diagnosed FFI by molecular-genetic investigation who suffered from increasing memory- and sleep-disturbance as well as physical restlessness and impotence for 9 months. Clinical features were motor symptoms, generalized myoclonus and hyperactivity with reduced attention and concentration. The neuropsychological findings were a severe disturbance of attention and memory as well as incipient deficits in executive functions. The cranial MRI and repeated EEG were normal; in detailed laboratory tests including CSF no abnormalities were detected. The clinical course was characterized by rapid decline of the motor and cognitive skills; the patient died 15 months after onset. Histological analysis showed the typical changes of FFI (spongiform changes at hippocampus and regio entorhinalis, severe gliosis in the thalamus and mild deposits of abnormal prion protein).     

Inherited prion disease caused by the V210I mutation: transmission to transgenic mice.

OBJECTIVE: To describe the clinical and neuropathologic profile and determine the strain characteristics of familial Creutzfeldt-Jakob disease (fCJD) caused by a point mutation of the PRNP gene at codon 210 that results in a valine-to-isoleucine substitution in the prion protein (PrP). METHODS: The clinicopathologic features of four individuals from the United States who died of fCJD(V210I) were compared. Transgenic (Tg) mice expressing a chimeric human-mouse PrP transgene were inoculated with brain extracts from three fCJD(V210I) cases, sporadic CJD (sCJD), fCJD(E200K), and fatal familial insomnia (FFI), to compare prion strain characteristics. RESULTS: The clinicopathologic profile of fCJD(V210I) was variable among cases but shared similarities with sCJD. The pattern of PrP(Sc) deposition in the brains of Tg mice was similar to that caused by sCJD but different from that associated with fCJD(E200K) or FFI. CONCLUSIONS: Each of these prion diseases is characterized by a rapidly progressive dementia with myoclonus, periodic complexes on EEG, and spongiform change without PrP plaque deposition in the brain. The occurrence of a different PrP(Sc) phenotype with each PRNP mutation argues that each respective amino acid sequence substitution produces a different prion strain.     

Inherited prion encephalopathy associated with the novel PRNP H187R mutation: a clinical study

OBJECTIVE: To describe a variant of prion encephalopathy associated with the recently identified H187R mutation in the prion protein (PRNP) gene. METHODS: The authors studied a multigenerational American family with nine affected individuals. Clinical examination included imaging, EEG, and CSF analysis with 14-3-3 protein testing. Histopathology was characterized by examination of a brain biopsy from an H187R mutation-positive patient. RESULTS: The disease in this family is caused by the PRNP H187R mutation and characterized by autosomal dominant inheritance, median age at disease onset of 42 years (range 33 to 50 years), and median duration of illness of 12 years (range 8 to 19 years). Clinical signs include progressive dementia, ataxia, myoclonus, and seizures. Histopathologic features consist of distinctive "curly" prion protein deposits with a strictly laminar distribution in the cerebral cortex and minimal astrogliosis in the absence of amyloid plaques or spongiosis. CONCLUSION: A variant of prion encephalopathy associated with the novel H187R mutation in the PRNP gene displays distinctive clinical and immunostaining characteristics that further expand the boundaries of human prion disease.     

PRNP H187R mutation associated with neuropsychiatric disorders in childhood and dementia

Described is a large family with an autosomal dominant dementia associated with an H187R mutation in the prion protein gene (PRNP). Clinical features include neuropsychiatric disturbances in childhood and adolescence, dementia in young adulthood with frontotemporal manifestations, and long disease duration. Neuropathology revealed atrophy and mild gliosis, whereas prion protein analysis revealed an abnormal conformer with unusual sensitivity to protease digestion. Mutations in PRNP may cause neuropsychiatric disorders that predate dementia by many years.     

Mutation at codon 210 (V210I) of the prion protein gene in a North African patient with Creutzfeldt-Jakob disease.

A point mutation at codon 210 of the prion protein gene (PRNP), resulting in the substitution of isoleucine for valine (V210I) has been found in a 54-year-old Moroccan patient affected with Creutzfeldt-Jakob disease (CJD). This patient is the first carrier of the PRNP V210I mutation reported from North Africa. The clinical presentation of the patient was rather similar to that seen in classical CJD, except that unusual early sensory symptoms were observed. The mother of the proband, aged 72, is a further example of an asymptomatic elderly carrier of the PRNP V210I mutation, suggesting an incomplete penetrance of the disease.