应用荧光原位杂交诊断性染色体异常和绒毛细胞的产前诊断

本文应用近年发展起来的荧光原位杂交（fluorescence in situ hybridization,FISH)技术,对非整倍体染色体45,XX、47,XXX、47,XXY、47,XYY等性染色体异常以生物素标记的X着线粒探针和Y长臀探针进行检测,同时与正常46,XX和46,XY核型作对照,并对两例绒毛细胞作了产前性别诊断,都取得了良好的诊断效果。与常规的诊断有快速、准确、特异等优点。诊断非整倍体性染色体异常和绒毛细胞的产前性别诊断技术性能可靠。为临床多种材料的FISH技术检测打下了基础。     

无创产前筛查后FISH在产前诊断中的应用价值

目的探讨荧光原位杂交(FISH)技术在产前诊断胎儿染色体异常中的临床应用价值和现状。方法对99例孕17-23周、有产前诊断指征(25例经无创产前筛查为阳性)的孕妇,在B超引导下经腹抽取羊水后,应用特异性探针针对未经过培养的羊水间期细胞进行荧光原位杂交。同时进行常规羊水细胞培养和核型分析。结果 FISH和核型分析共检出染色体数目异常21例,异常率为21.2%,分别为15例21-三体、6例18-三体,结果一致;染色体核型分析检测出4例结构异常:46,XX,15ph+、46,XY,add(3)(p26.3)、46,XX,t(7;19)(p15;p13)、46,XX,inv(9)(p11q12)。结论在产前诊断中FISH检测适用于染色体(13,18,21,X,Y)数目异常的的快速诊断,缩短孕妇等待时间,减轻孕妇的焦虑。不能检测出结构异常,不能单独用于产前诊断。     

宜昌地区427例高危孕妇羊水细胞染色体核型结果分析

目的 分析宜昌地区羊水染色体核型,总结宜昌地区羊水细胞染色体核型异常核型出现的类型、发生率及相关影响因素,为产前诊断提供依据。方法 对产前筛查高危孕妇进行羊水穿刺、细胞培养、染色体制备、G显带以及核型分析。结果 羊水细胞培养成功率为99.1%(427/431),发现异常核型25例,异常检出率为5.9%(25/427)。其中,21-三体7例,18-三体3例,13-三体1例,46,XX[16]/47,XX+mar[2];47,XXY;46,XY[1]/47,XXY[24];46,XX[7]/47,XXX[1];46,XXq-[14]/45,XO[6];45,XO;46,XN inv(9)各1例,染色体多态7例。结论 宜昌地区产前筛查高危孕妇羊水细胞染色体核型异常检出率较高,主要为常见的三体综合症,性染色体异常及染色体多态。其中,21-三体发生率和染色体多态较高,性染色体异常次之。     

应用双色荧光原位杂交技术诊断性染色体异常疾病

目的探讨双色荧光原位杂交技术(FISH)对性染色体异常诊断的价值.方法应用X、Y染色体着丝粒探针对29例常规染色体分析疑有性染色体异常患者的外周血或间期细胞进行杂交.结果29例均证实有性染色体异常,其类型包括:45,X(10)、45,X/46,XX(2)、45,X/46,Xr(X)(1)、47,XXY(13)、47,XYY(2)和47,XXX(1)等多种.结论FISH技术可以准确而快速地诊断性染色体的异常,是传统细胞遗传学的必要补充.     

1075例产前诊断中32例染色体异常胎儿预后分析

目的探讨胎儿染色体异常与产前诊断的高危因素的关系及胎儿预后。方法回顾性分析2004年10月至2009年8月间在我院因各种原因行羊膜腔穿刺或脐带血穿刺产前诊断的胎儿染色体核型。结果总共1075例产前诊断中共发现胎儿染色体异常32人,染色体异常检出率2.97%。其中检出45,XY,t(21.14)1例,双胎均为46,XX,22Pstk+1例,47,XY,+(?),1例,46,XX,t(8;16)1例,46,XY,t(1;18)1例,46,XY,t(2;14)1例,46,XX,t(11;12)1例,产前诊断指征均为夫妻双方之一染色体平衡异位。46,XY,inv(Y)1例,产前诊断指征为生育过唐氏综合征。46,XY,inv(9)10例,产前诊断指征为羊水少,单脐动脉1人,孕期使用胚胎毒性药物使用史1人,唐氏征筛查高危4人,高龄2人,地中海贫血1人。47,XXY1例,产前诊断指征为胎儿双肾盂分离。唐氏综合征6例,产前诊断指征为唐氏征高危2人,高龄3人,NT值高1人。47,XYY2例,产前诊断指征为唐氏征高危1人,高龄1人。47,XXY/46,XX1例,产前诊断指征为唐氏征高危。18-三体3例,产前诊断指征为高龄1人,NT值高1人,18,13-三体高危1人。结论夫妻双方之一染色体平衡异位胎儿染色体核型异常类型多样。唐氏综合征及18-三体胎儿常见于高龄,血清学筛查高危,NT值升高孕妇。孕11-14周B超测NT值及孕中期血清学唐氏综合征筛查可以提高产前诊断的效率,减少出生缺陷。     

用间期细胞FISH技术快速分析性腺发育不全患者的性染色体数目异常

目的探索用间期细胞FISH快速分析男性性腺发育不全患者染色体数目异常的方法.方法应用生物素和地高辛分别标记X染色体特异性人工细菌染色体(BAC)DNA以及Yq12区域重复序稽pY3.4 DNA,对15例男性性腺发育不全患者外周血淋巴细胞间期核进行双色荧光原位杂交(FISH)分析.结果淋巴细胞间期核FISH和常规染色体分析结果一致,可发现47,XXY、46,XX和46,XY/47,XXY嵌合体等.结论间期双色FISH可以快速分析男性性腺发育不全患者的性染色体数目异常,为临床诊断提供依据.     

应用荧光原位杂交技术对染色体病进行诊断

本文应用生物素标记的X -α着丝粒探针、特异区域单拷贝序列探针 2 1q2 2 .3;地高辛标记的重复序列探针pY3.4分别对 7例性腺发育不全、5例唐氏综合症患者外周血染色体及间期细胞核进行单色及双色荧光原位杂交 (FISH)。用染色体成像系统摄影并后期处理 ,显示的异常核型有 :45 ,XX/4 7,XXX ;45 ,XO/4 6 ,Xi(Xq) ;45 ,XO/4 6 ,XX ;47,XX 2 1;47,XY 2 1;47,XXY。中期分裂相FISH杂交结果与染色体G显带核型分析一致 ,间期细胞中荧光信号的数目与预期一致。     

用FISH技术快速诊断胎儿常见染色体数目异常

目的探讨荧光原位杂交(FISH)技术在产前诊断中的应用价值.方法采用13、18、21、X和Y染色体特异性DNA探针,对114例孕15～37w孕妇的羊水间期核进行FISH检测,同时行常规羊水细胞核型分析.结果与羊水细胞核型分析相符的染色体正常111例,异常3例,(47,XX 21、47,XY 21和46,XX,-21, t(21;21);另有1例核型为46,XY,t(15;18)(q26;q22),FISH信号显示正常.3例数目异常胎儿引产时抽脐血染色体检查结果与产前诊断一致.结论FISH技术用于产前诊断常见染色体数目异常,具有简便、快速、特异性强等优点,但有一定的局限性.应与常规核型分析相结合方可为临床提供更为真实可靠的信息.     

新疆地区荧光原位杂交产前诊断非整倍体的应用价值

目的探讨荧光原位杂交（FISH）技术产前诊断常见染色体非整倍体的应用价值。方法采用21、18、13、和Y染色体特异性DNA探针对96例孕18～23周孕妇的未培养羊水细胞进行FISH检测,同时行羊水细胞染色体核型分析。结果 FISH检测98例成功96例（97.9%）,其中染色体数目正常93例（48例为46,XX;45例为46,XY）染色体数目异常3例（2例47,XX,＋21;1例47,XX＋18）。FISH诊断结果与核型分析结果一致,染色体数目异常的3例与传统核型分析结果完全一致。结论 FISH技术用于产前诊断常见染色体非整倍体,具有简便、快速、特异性强敏感性高、所用样本量少等优点。     

75例孕中期性染色体异常的细胞遗传学分析

目的通过分析孕中期不同的高危指征与胎儿性染色体异常之间的联系,探讨性染色体异常的产前诊断指征。方法统计分析2009年1月至2014年4月,来我院遗传门诊行羊膜腔穿刺的15 920例患者,制备染色体和核型分析。结果 15 920例羊水产前诊断标本,共检测出75例性染色体异常,其中以17例45,X;10例46,X,inv(Y);9例45,X(m)/46,XX(n);9例47,XXY等为主。结论孕妇在孕中期具有唐氏血清学筛查高危、高龄妊娠或B超检查软指标异常或父母地贫携带者等,这类孕妇具有生育出携带性染色体数目异常或结构构异常胎儿的风险。做好产前诊断是减少出生缺陷儿的重要举措。     

大连地区78例Turner综合征的临床特征与染色体核型分析

目的探讨Turner综合征（TS）不同核型的遗传学特征、临床特点及其所占比例。方法成人外周血染色体核型分析,高危孕妇羊水染色体核型分析。结果成人外周血检测发现TS 75例,羊水检测发现TS 3例。78例患者中,45,XO 32例（41%）,45,XO/46,XX嵌合型10例（12.8%）,45,XO/46,XX/47,XXX嵌合型2例（2.6%）,45,XO/47,XXX嵌合型4例（5.1%）,46,X,i（X）4例（5.1%）,45,XO/46,X,i（X）嵌合型9例（11.5%）,46,X,del（Xp-）7例（9.0%）,46,X,del（Xq-）7例（9.0%）,45,XO/46,X,del（Xp11）嵌合型2例（2.6%）,45,XO/46,X,del（Xq21）嵌合型1例（1.3%）。结论 TS核型主要包括X单体型,X单体嵌合型和结构畸变型及其嵌合型三种,45,XO的X单体型为本综合症的主要类型;不同核型患者临床表现可存在差异;对有相关临床表现的女孩争取做到早诊断,早治疗;对部分具有一定生育能力的TS患者做好产前诊断,做到优生优育。     

Mosaicism for a small supernumerary ring X chromosome in a dysmorphic, growth-retarded male: mos47,XXY/48,XXY, + r(X)

Supernumerary ring X [r(X)] chromosomes are often found in patients with Turner syndrome. The phenotypic effects of the r(X) chromosome are variable, and largely depend on the presence or absence of the X inactivation (XIST) locus. Ring(X) chromosomes in males are rare and have been previously reported in only four cases, with 47,XY, + r(X) or mos47,XY, + r(X)/46,XY karyotypes. These patients all had developmental delay and dysmorphic features. We describe a 2.5-year-old male patient with facial dysmorphia, growth retardation, microcephaly, global developmental delay, and microphallus. Cytogenetic analysis from peripheral blood lymphocytes and fibroblasts identified mosaicism for two cell lines: mos48,XXY, + r(?X)/47,XXY. Fluorescence in situ hybridization (FISH) with an X chromosome paint showed the ring chromosome to be X chromosome derived. This is the first case of an r(X) chromosome described in a 47,XXY patient. FISH analysis of the r(X) chromosome with an XIST probe showed that the XIST locus was absent. Functional disomy of genes in the r(X) chromosome most likely accounts for the abnormal phenotype in the proband.     

Results and Pitfalls in Prenatal Cytogenetic Diagnosis

Since 1969, we have cultured over 200 diagnostic amniotic fluids. Of these, 183 were for cytogenetic diagnosis. The chromosome analysis was successful in 168 cases. The indications and the results of the affected fetuses (followed by therapeutic abortion) are: (1) previous child with Down's syndrome: 62 cases (1:47,XX,+21); (2) advanced maternal age: 54 cases (1:47,XXY; 1:45,X/46,XY mosaicism; 1:47,+18); (3) previous child with multiple anomalies: 12 cases; (4) previous child with 47,XY,+18 or 47,+13: five cases; (5) translocation carrier: two cases; (6) parental mosaicism: three cases; (7) X-linked disorders: six cases (3:XY); (8) others: 24 cases. We have found firstly, that for prenatal sex determination, karyotype analysis of the cultured amniotic fluid cells is the only accurate means and that caution must be taken if sex chromatin and Y-fluorescent body determination from the uncultured amniotic fluid cells is used. Secondly, that diagnosis of chromosomal mosaicism can be problematic as exemplified by our case of 45,X/46,XY mosaicism, where only 45,X cells were recovered from the first culture. Thirdly, that in cases with enlarged satellites, cells of late prophase or early metaphase must be used to eliminate confusion with translocations. We encountered three cases of enlarged satellites—one in the D group and two in the G group—and all three resulted in normal infants. Fourthly, that the karyotype may be altered by contamination and/or treatment or other unknown factors. We have observed two such cases where each mother delivered a normal infant.     

A variant Klinefelter syndrome patient with an XXY/XX/XY karyotype studied by GTG-banding and fluorescence in situ hybridization.

Klinefelter syndrome is the first human sex chromosomal abnormality to be reported. The majority of Klinefelter syndrome patients have the XXY karyotype. Approximately 15% of Klinefelter patients, however, are mosaics with variable phenotypes. Among the variant Klinefelter genotypes are such karyotypes as XY/XXY and XX/XXY. The variation in phenotypes most likely depends on the number of abnormal cells and their location in body tissues. In this paper we report the case of a 42-year-old patient with Klinefelter syndrome and a rare variant mosaic XXY/XX karyotype initially identified by GTG-banding. This was confirmed by fluorescence in situ hybridization (FISH) using a dual-color X/Y probe. The patient presented with erectile dysfunction and few other physical findings. Thus, this case illustrates a rare variant of Klinefelter syndrome with a relatively mild phenotype. It also illustrates the utility of FISH as an adjunct to conventional cytogenetics in assessing the chromosome copy number in each cell line of a mosaic. In our case, FISH also detected the presence of a small population of cells with the XY karyotype not previously detected in the initial 30-cell GTG-banding analysis. Thus, through a combination of GTG-banding and FISH, the patient was determined to be an XXY/XX/XY mosaic. Given that most individuals with Klinefelter syndrome are infertile, and that these individuals may wish to reproduce with the aid of modern reproductive technology, such as testicular fine needle aspiration and intracytoplasmic sperm injection, it is important that accurate estimation of the frequency of abnormal cells be obtained for accurate risk estimation and genetic counseling, as recent studies in patients with mosaic Klinefelter syndrome revealed that germ cells with sex chromosomal abnormalities were nevertheless capable of completing meiosis.     

18例闭经患者的分子-细胞遗传学研究

目的探讨荧光原位杂交（fluorescencein situhybridization,FISH）和高分辨比较基因组杂交（highresolution-comparative genomic hybridization,HR-CGH）技术在闭经研究中的应用价值。方法17例原发闭经和1例继发闭经患者经常规妇科检查、B超及内分泌功能检查后,应用染色体核型分析,部分染色体异常患者采用FISH和HR-CGH技术相结合的分子-细胞遗传学检查诊断结果,并对其临床症状及发病机制进行了探讨。结果17例原发闭经患者中,7例为46,XX的正常女性核型;10例携带有异常染色体核型,所占比例为58.8%,其中3例为46,XY的女性患者,2例为45,X及45,X/46,XX的Turner＇s患者;其余5例均为携带有X染色体结构异常,包括X染色体部分单体、X等臂染色体和X/Y嵌合体等异常核型患者;1例继发性闭经患者为X染色体与常染色体易位的异常核型。结论应用FISH和HR-CGH技术与高分辨染色体显带技术,精确诊断患者的染色体核型,可为临床的诊断和治疗提供医学遗传学依据。     

外周血性染色体异常患者精子染色体分析及植入前遗传学诊断

目的探讨外周血性染色体异常患者的精子染色体组成，评估其胚胎性染色体异常的风险，为胚胎植入前遗传学诊断（preimplantation genetic diagnosis，PGD）的应用提供客观依据。方法应用三色荧光原位杂交技术fluorescence in situ hybridization，FISH）对3例性染色体异常的患者（例1为46，XY／47，XXY，例2为45，XO／46，X，Yqh-，例3为47，XYY）进行精子X、Y和18号染色体分析，并对例2进行PGD。结果例2的X18：Y18精子的比例为2．05：1，总异常精子比例达29．71％，其中XY18、O18和XO均明显高于其它组。例3总异常精子比例占4．91％，XY18占1．87％。对例2进行PGD，移植1个XX1818胚胎。结论通过FISH检测性染色体异常患者的精子，有助于评估其胚胎性染色体异常的风险，从而选择性应用胚胎植入前遗传学诊断。     

Mosaic Turner syndrome: cytogenetics versus FISH

Twenty-two cases with Turner syndrome features were subjected to standard cytogenetic techniques using giemsa trypsin (GTG-) banding then fluorescence in situ hybridization (FISH) using a specific whole-X chromosome painting probe, Quint-Essential Y-specific DNA probe (AMELY) for Yp11.2, alpha-satellite (DYZ3) probe and X/Y cocktail-alpha satellite probe (ONCOR) for confirmation of the initial diagnosis and comparison of the two techniques. Eight cases (36%) showed the same karyotype results by both techniques [5 cases: 45,X/46,XX, 2 cases: 45,X/46,X,i(Xq) and one case with a triple cell line 45,X/46,XX/47,XXX]. In the other 14 cases (64%) the FISH technique has identified a third cell line in 7 cases (32%), delineated the origin of the marker in 5 cases (23%) to be derivative X and clarified the deletion of the Yp11.2 region in 2 cases (9%) with the 45,X/46,XY karyotype. The application of FISH has highlighted the differences between the initial diagnosis based on the standard cytogenetic technique and the final diagnosis determined by the application of DNA probes specific for the X and Y chromosomes. FISH proved useful in detection of the low frequency cell lines which need analysis of a large number of metaphase spreads by GTG-banding, helped in identifying the nature and the origin of the unknown markers which has an important implication in the development of gonadal tumours and delineated the deletion of the Yp11.2 region in the 45,X/46,XY Turner patients.     

Karyotypic evolution in acute myelomonocytic leukemia with pericentric inversion of chromosome 16

A 37-year-old Japanese male patient with acute myelomonocytic leukemia subtype M4 (according to FAB classification) associated with bone marrow eosinophilia and specific chromosome abnormalities: a pericentric inversion of chromosome 16, inv(16)(p13q22); a long arm deletion of chromosome #7, del(7)(q22q34); and a gain of chromosomes #8 and #22 is reported. In addition to the modal karyotype, 47,XY,7q-,inv(16),+22, there were three other clones whose karyotypes were 46,XY,inv(16); 47,XY,inv(16),+22; and 48,XY,+8,inv(16),+22. As these karyotypes were related to each other, the presence of multiple clones indicated that karyotypic evolution had occurred. The karyotypic evolution associated with 7q- has not been reported previously in patients with M4Eo with inv(16).