三例性腺发育不全患者的细胞及分子遗传学分析

目的探讨性腺发育不全患者的遗传学病因。方法对3例性腺发育不全患者行常规的G显带分析和SRY基因检测。结果 2例患者的染色体核型分别为45,X和46,XY的嵌合体;1例患者染色体核型为46,XY。三者的SRY基因检测均为阳性。结论 (1)45,X/46,XY的嵌合型染色体核型形成原因可能是Y染色体结构存在异常致使染色体不稳定发生丢失,因而产生了45,X细胞系。(2)3例患者的SRY基因检测均为阳性的细胞学基础可能是X/Y异常交换与基因突变所致。     

性分化异常患者的细胞及分子遗传学分析

目的通过对20例性分化异常患者进行细胞遗传学及分子遗传学分析,为临床诊断提供参考,并对性分化异常机制进行探讨。方法应用染色体G显带与聚合酶链反应对性分化异常患者进行染色体核型分析与SRY基因的检测。结果7例Turner综合征患者均为SRY（-）,其中1例核型为45,X/46,XY;1例45,X/47,XYY/46,XY及SRY（-）患者为嵌合型女性性反转。46,XY及SRY（＋）患者中有1例为睾丸女性化综合征、1例为XY单纯性腺发育不全、6例为男性化男性假两性畸形。而4例46,XX及SRY（-）患者为先天性肾上腺皮质增生。结论对性分化异常患者进行染色体核型分析及SRY基因检测,有利于了解该类患者的遗传学病因,为其诊断和治疗提供科学的依据。     

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。     

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。     

46,XY女性性反转综合征的细胞遗传学诊断

目的探讨46,XY女性性反转综合征及人类的性别决定与性别分化的细胞遗传学诊断。方法外周血淋巴细胞培养染色体核型分析技术和荧光原位杂交(FISH)技术确定患者的染色体核型。结果 1名社会性别为女性的外周血染色体核型分析结果为:46,XY。结论细胞遗传学染色体核型分析技术和FISH技术均可确诊46,XY女性性反转综合征—染色体性别与性腺性别不相符。     

核型45,X/46,XY的Turner综合征患者的发病机理

目的 探讨核型为45,X/46,XY的Turner综合征患者的发病机理.方法 应用细胞遗传学G显带、C显带技术确定核型,进一步用荧光原位杂交技术证实;再应用PCR技术对2例患者进行性别决定基因(sex-determining region of the Y,SRY)扩增,并将扩增产物在ABI-377测序仪上测序.结果 病例1的染色体核型为45,X/46,X,del(Y);病例2的染色体核型为45,X/46,XY,荧光原位杂交技术也证实了X染色体和Y染色体同时存在;2例患者SRY基因扩增均为阳性,并且2例SRY阳性的患者DNA序列分析均未检测到突变.结论 Turner综合症患者的病因不单纯只由性染色体异常导致,可能与SRY以外的性别决定基因的突变或调节失常有关.     

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.     

检验、细胞遗传学指标在2例46,XY单纯性腺发育不全的应用分析

目的本文对2例B超异常病人行细胞遗传学检查及激素等检验,为临床鉴别诊断提供依据和思路。方法行外周血染色体细胞培养法,常规G显带染色体核型分析。并行相关性激素和肿瘤标志物等检验。结果发现2例46,XY单纯性腺发育不全:病例1伴始基子宫,总睾酮(TES):1268.00ng/dl(正常值0-73ng4/dl);病例2伴混合性生殖腺恶性肿瘤(以精原细胞瘤为主约占95%,伴卵黄囊瘤约占5%),多种肿瘤标志物(女):甲胎蛋白768.35ng/ml(正常值<10ng/ml)。结论应重视对46,XY单纯性腺发育不全者的细胞遗传学检查并结合检验结果分析,以利早期发现,避免误诊、漏诊、延误治疗,导致癌变。     

男性不育患者的细胞遗传学和分子遗传学研究

目的应用细胞遗传学和分子遗传学的检查，对男性不育患者的病因进行分析，探讨其遗传效应及其对生殖的影响。方法采用外周血染色体G显带、C显带技术和多重聚合酶链反应技术，对4例男性不育患者进行了细胞遗传学和分子遗传学检测。结果 4例男性不育患者中3例染色体都发生明显的形态学改变，1例未见异常，核型分别为：①45,X,-Y, der(Y)，t(Y;22)(q11.21;q11.2),-22；②46,X,del(Y)(q11.21)；③46,XY,t(1;12)(p32;q24)；④46,XY在所选择AZF的AZFa、AZFb、AZFd、AZFc区域的15个序列标签位点（STS）中，1例有13个位点缺失，1例12个位点缺失，1例1个位点缺失，1例5个位点缺失。结论对男性不育患者进行细胞遗传学及Y染色体AZF区域微缺失检查是必要的，为不育症患者提供明确的遗传学诊断.     

荧光原位杂交技术在遗传病诊断中的应用

目的探讨荧光原位杂交(fluorescenceinsituhybridization,FISH)技术在遗传病和产前诊断中的应用价值。方法应用着丝粒探针、特异性序列探针及染色体涂染探针等对36例常规核型分析疑有染色体异常患者的外周血和45例进行产前诊断的孕妇羊水间期细胞或中期分裂相进行FISH检测。结果检出的染色体异常类型有45,X、45,X/46,XX、45,X/46,Xr(X)、46,X,i(Xq)、47,XXY、46,XX,t(4;7)、47,XYY、47,XXX、47,XXY,inv(7)、46,XY,inv(7)、47,XX, 21,同时产前诊断出两例异常胎儿,分别是47,XX, 18和46,XY,der(15)t(Y;15)。结论FISH技术可以准确、快速地诊断各种染色体异常,是传统细胞遗传学的必要补充,可广泛用于遗传病诊断及产前诊断。     

Detection of Y chromosome sequences in a 45,X/46,XXq– patient by Southern blot analysis of PCR-amplified DNA and fluorescent in situ hybridization (FISH)

In some cases of gonadal dysgenesis, cytogenetic analysis seems to be discordant with the phenotype of the patients. We have applied techniques such as Southern blot analysis and fluorescent in situ hybridization (FISH) to resolve the phenotype/genotype discrepancy in a patient with ambiguous genitalia in whom the peripheral blood karyotype was 45,X. Gonadectomy at age 7 months showed the gonadal tissue to be prepubertal testis on the left side and a streak gonad on the right. The karyotype obtained from the left gonad was 45,X/46,XXq- and that from the right gonad was 45,X. Three different techniques, PCR amplification, FISH, and chromosome painting for X and Y chromosomes, confirmed the presence of Y chromosome sequences. Five different tissues were evaluated. The highest percentage of Y chromosome positive cells were detected in the left gonad, followed by the peripheral blood lymphocytes, skin fibroblasts, and buccal mucosa. No Y chromosomal material could be identified in the right gonad. Since the Xq- chromosome is present in the left gonad (testis), it is likely that the Xq- contains Y chromosomal material. Sophisticated analysis in this patient showed that she has at least 2 cell lines, one of which contains Y chromosomal material. © 1995 Wiley-Liss, Inc.     

Discordant phenotypes and 45,X/46,X,idic(Y).

Mosaicism introduces wide variability into the clinical expression of numerical and unbalanced structural chromosomal abnormalities. The phenotypic range of variability of 45,X/46,XY mosaicism extends from Turner syndrome to mixed gonadal dysgenesis to normal males. The specific phenotype is primarily dependent on the chromosomal constitution of the developing gonad. Similar phenotypic variability is observed with mosaicism for 45,X and a second cell line with an abnormal sex chromosome. This report describes a patient with Turner syndrome and a patient with mixed gonadal dysgenesis who have identical karyotypes, namely 45,X/46,X,idic(Y)(p11.2). While mosaicism alone might have accounted for the phenotypic differences, by PCR analysis the Turner syndrome patient was SRY and ZFY negative and the mixed gonadal dysgenesis patient was SRY and ZFY positive.     

Unusual mixed gonadal dysgenesis associated with Müllerian duct persistence, polygonadia, and a 45,X/46,X,idic(Y)(p) karyotype

Mixed gonadal dysgenesis (MGD) is a developmental anomaly in which most of the patients have a dysgenetic testis, a contralateral streak and a 45,X/46,XY karyotype. This entity involves an heterogeneous group of gonadal and phenotypic abnormalities with a wide clinical spectrum. The phenotype depends on the ratio of testicular tissue which induces virilization. Although the karyotype in these patients is 45,X/46,XY, no genotype-phenotype correlation has been found to date. Müllerian ducts persistence (MDP) in MGD is rare; however, four patients with both entities and different karyotypes have been described. Here we present the data on a newborn patient with an atypical MGD associated with MDP, two left testes, a gonadal streak on the right, and absence of Wolffian derivatives. PCR analysis identified all the Y-derived sequence tested in the father, while the patient had them all except the AZF b,c regions which were lost. FISH analysis of the paternal Y chromosome documented Yq paracentric inversion while the patient's karyotype was 45,X/46,X,idic(Yp). No mutations were observed in MIS/MISRII genes.     

FISH and PCR analysis of the presence of Y-chromosome sequences in a patient with Xq-isochromosome and testicular tissue

Mixed gonadal dysgenesis includes a heterogeneous group of different chromosomal, gonadal, and phenotypic abnormalities, characterized by the presence of a testis on one side and streak or an absent gonad on the other, persistence of müllerian duct structures and/or wolffian derivatives, and a variable degree of genital ambiguity. Here, we describe a patient with virilized external genitalia and phenotypic features of Turner syndrome, whose blood karyotype was 45,X/46,X,i(Xq). The presence of a unilateral dysgenetic testis was confirmed by histopathology. Using fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR)-based analysis to detect Y-specific sequences, Y-chromosome material was not detected. To date, this is the first case reported of Xq-isochromosome associated with the presence of testicular tissue.     

枣庄地区200例原发闭经患者的细胞遗传学分析

目的探讨原发闭经患者与细胞染色体异常的关系。方法选择在我院就诊的原发闭经患者200例,对每例患者进行外周血培养、染色体核型分析和妇科检查。结果在200例原发闭经患者中,检查出核型异常90例,异常核型检出率为45%（90/200）。在检出的异常核型中,Turner综合征患者48例,占53.3%（48/90）;46,XY 19例,占21.1%（19/90）;嵌合体/染色体结构异常23例,占25.6%（23/90）。结论性染色体结构或数目异常,可导致患者身材矮小、性腺发育不全、两性畸形、不孕、闭经等临床表现。通过细胞染色体核型分析,不仅为原发闭经患者寻找病因提供了理论依据,而且有利于对患者的治疗进行科学指导。     

Mixed gonadal dysgenesis and sex chromosome mosaicism with multiple cell lines including structural aberrations of the Y chromosome

A case of mixed (asymmetric) gonadal dysgenesis is reported in a girl with ambiguous external genitalia, a right intra-abdominal testis, a left streak gonad containing follicle-like structures devoid of oocytes and bilateral Mullerian derivatives. Buccal smear cells were X-chromatin negative and a Y-chromatin body was present in 31% of cells. Cytogenetic studies in peripheral blood leucocyte cultures showed sex chromosome mosaicism with cell lines including structural abnormalities of the Y chromosome in 36% of the cells: 45, X/46, XY/46, X, + i(Yp)/46, X, + Yq–/47, XYY/47, XY + Yq-.     

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.     

The X linked recessive form of XY gonadal dysgenesis with a high incidence of gonadal germ cell tumours: clinical and genetic studies.

Five phenotypic females in one family had the genotype 46,XY and all had gonadal germ cell tumours. Studies of the family pedigree suggest that this form of XY gonadal dysgenesis is inherited in an X linked recessive manner. G banding of elongated metaphase chromosomes from two subjects with XY gonadal dysgenesis and a female carrier showed no aberrations of the X chromosome. The titres of H-Y antigen in three girls with XY gonadal dysgenesis were in the male control range. Thus it appears that, in the X linked form, XY gonadal dysgenesis may be caused by a point deletion or mutation of a gene on the X chromosome, which controls the gonad specific receptor for the H-Y antigen. Studies of Xg blood groups were uninformative about linkage of Xg with the X borne gene causing the XY gonadal dysgenesis. Dermatoglyphic studies in the girls with XY gonadal dysgenesis and female carriers revealed high a-b palmar ridge counts and a tendency for the A mainline to terminate in the thenar area. Both of these features have been described in patients with Turner's syndrome.