4例女性Prader-Willi综合征患儿的内分泌代谢特点

4例Prader-Willi综合征(PWS)患儿均为女性,确诊年龄6~12岁,均有肥胖,特殊面容,发育迟缓、智力障碍等临床表现,遗传学检测提示其中2例为15q11.2-q13区域父源性缺失,1例为15q11.2-q13区域母源性同源二倍体,1例15q11.2-q13区域未发现异常。4例患者存在不同程度的内分泌代谢紊乱:2例身材矮小,其中1例第二性征延迟,另1例合并2型糖尿病;1例表现为胰岛素抵抗,无乳腺发育;1例患儿的身高处于P_3~P_(10),性早熟。PWS患者存在多种内分泌功能紊乱,长期内分泌专科随访及管理十分重要。     

新生儿Prader-Willi综合征14例临床表型与基因型分析

目的观察Prader-Willi综合征(PWS)新生儿期的临床表现,结合基因检测结果,分析临床表型与基因型之间的关系,为临床早期筛选PWS相关患者及进一步行分子诊断提供线索。方法 2013年3月至2016年12月在广东省妇幼保健院出生或门诊就诊的新生儿3321例,根据临床表现,首先采用甲基化特异性聚合酶链式反应(MS-PCR)进行初筛,对临床表现可疑患儿或MS-PCR初筛阳性者,进一步采用多重荧光PCR-STR连锁分析、染色体微阵列分析等方法,进行确诊。对确诊的PWS患儿,进一步对临床表型和基因型进行分析,探索其中的联系。结果 14例PWS新生儿中,男8例,女6例,年龄1~28 d,其中足月儿10例,早产儿3例,过期产儿1例。14例患儿中,11例为父源性15q11.2-q13区域缺失,3例为母源性单亲二倍体(1例为同源性单亲二倍体,2例为异源性单亲二倍体)。父源性缺失型组,11例患儿均存在肌张力低下、皮肤毛发色素减退和哭声低(100%),吃奶吸吮缓慢6例(54.5%)、男性隐睾或睾丸下降不良4例(36.4%)、小阴茎4例(36.4%)、女性阴唇发育不良1例(9.1%)、唾液黏稠3例(27.3%)、特殊面容9例(81.8%)。母源性单亲二倍体组,3例患儿均存在肌张力低下(100%),皮肤毛发色素减退2例(66.7%)、吃奶吸吮缓慢2例(66.7%)、哭声微弱2例(66.7%)、女性小阴唇1例(33.3%);无特殊面容和唾液黏稠,均不需特殊喂养。结论新生儿期中枢性肌张力低下、皮肤毛发色素减退、哭声减弱是PWS新生儿普遍存在的特征,可作为进一步行PWS分子诊断的初步筛选指标。     

Prader-Willi综合征46例临床分析

目的探讨新生儿期至青春期Prader-Willi综合征(PWS)患儿的临床特点和诊断方法。方法对2010年1月至2016年1月重庆医科大学附属儿童医院收治的46例PWS患儿临床特点及基因检测结果进行回顾性分析。结果 46例PWS患儿,男28例,女18例,男女比例3∶2。初次就诊年龄0~9岁,确诊年龄14 d至14岁,病程最长达9年。主要临床表现为肌张力低下28例(60%)、喂养困难20例(44%)、哭声低下18例(40%)、智能障碍42例(92%)、肥胖25例(55%)及身材矮小26例(57%)等。各年龄段临床表现不同:新生儿(0~28 d)主要表现为肌张力低下、哭声弱、吸吮力差;婴儿(28 d至1岁)主要表现为运动发育落后、肌张力低下、哭声弱、吸吮力差、特殊面容及皮肤色素减退等;幼儿(1~3岁)主要表现为运动智力发育落后、肌张力低下、皮肤色素减退等;3岁以上患儿出现智力发育落后、食欲亢进及肥胖、身材矮小、外生殖器发育不全。44例为父源性15q11-13区域缺失(96%),2例为母源单亲二倍体(4%)。结论各年龄段PWS患儿临床表现不同,尽早行基因检测有助于早期诊断。     

甲基化特异性MLPA技术在Prader-Willi综合征诊断中的应用价值

目的：不同发病机制的Prader-Willi综合征（PWS）在临床表现、预后和遗传风险上均存在一定差异,目前临床常用的确诊方法甲基化特异性PCR（MS-PCR）不能区分发病机制,本研究采用甲基化特异性多重连接依赖的探针扩增（MS-MLPA）技术诊断PWS,探讨其在诊断以及分辨发病机制上的优势。方法：采用系统对照的方法,取经临床MS-PCR检查的30例患儿的外周血样本,其中包括通过MS-PCR确诊为PWS的病例16例,阴性对照病例14例,重新提取DNA,采用MS-MLPA试剂盒Me028进行基因检测分析。结果MS-MLPA检测结果与MS-PCR检测结果一致,且检测出16例PWS病例中4例源于母源性同源二倍体,12例源于父源性15q11-q13区域缺失。结论：MS-MLPA是能鉴别PWS发病机制的一种可靠的实验诊断方法。     

Prader-Willi综合征Ⅰ型和Ⅱ型缺失新生儿表型分析

目的 分析Prader-Willi综合征（PWS）父源性Ⅰ型、Ⅱ型缺失新生儿的表型差异。方法 纳入在复旦大学附属儿科医院临床诊断为PWS的新生儿,应用甲基化特异性多重连接探针扩增技术（MS-MLPA）和SNP芯片检测方法行PWS基因型分类,收集父源性Ⅰ型、Ⅱ型缺失患儿的临床表型资料,分析表型的差异。结果 13例PWS父源性缺失新生儿进入分析,其中MS-MLPA诊断10例,3例采用Affymetrix SNP芯片筛查诊断。Ⅰ型缺失5例,平均胎龄为36.2周,3例早产;Ⅱ型缺失8例,平均胎龄为38.9周,均为足月儿。Ⅰ型和Ⅱ型缺失各表型的发生率：肌张力低下和吸吮力差均为100%,特殊面容分别为80%和50%,色素减退分别为40%和37.5%,生殖系统异常分别为40%和87.5%。结论 肌张力低下和吸吮力差是PWS新生儿共同的临床特征,Ⅰ型缺失可能更易发生早产,特殊面容;Ⅱ型缺失生殖系统异常发生率较高,Ⅰ型缺失可能存在临床表型多样性。     

Prader-Willi综合征的临床筛查和基因诊断

目的 探讨临床疑似Prader-Willi综合征（PWS）患儿的临床筛查、基因诊断及确诊病例临床诊断评分结果的差异。方法 选取2016年7月至2018年12月收治的临床疑似PWS患儿94例为研究对象,应用甲基化特异性多重连接依赖性探针扩增（MS-MLPA）技术进行检测,对确诊患儿采用临床诊断评分进行评估,并分析确诊患儿的围生期特征。结果 MS-MLPA技术确诊PWS患儿11例,检出率为12%;其中男7例,女4例;中位确诊年龄3岁4个月（范围：25 d至6岁8个月）。11例PWS患儿中仅5例（45%）满足临床诊断标准。PWS患儿围生期主要特征有胎动减少9例（82%）、剖宫产11例（100%）、新生儿期肌张力低下11例（100%）、喂养困难11例（100%）及哭声低下11例（100%）。结论 对临床疑似的PWS患儿应及早进行基因检测确诊,单纯依靠临床诊断评分可能导致PWS漏诊。     

Prader-Willi综合征的临床筛查和基因诊断

目的 探讨临床疑似Prader-Willi综合征（PWS）患儿的临床筛查、基因诊断及确诊病例临床诊断评分结果的差异。方法 选取2016年7月至2018年12月收治的临床疑似PWS患儿94例为研究对象,应用甲基化特异性多重连接依赖性探针扩增（MS-MLPA）技术进行检测,对确诊患儿采用临床诊断评分进行评估,并分析确诊患儿的围生期特征。结果 MS-MLPA技术确诊PWS患儿11例,检出率为12%;其中男7例,女4例;中位确诊年龄3岁4个月（范围：25 d至6岁8个月）。11例PWS患儿中仅5例（45%）满足临床诊断标准。PWS患儿围生期主要特征有胎动减少9例（82%）、剖宫产11例（100%）、新生儿期肌张力低下11例（100%）、喂养困难11例（100%）及哭声低下11例（100%）。结论 对临床疑似的PWS患儿应及早进行基因检测确诊,单纯依靠临床诊断评分可能导致PWS漏诊。     

甲基化方法诊断3例Prader-Willi综合征

目的为临床怀疑Prader-Willi综合征（PWS）的患者建立快速准确的分子诊断方法,有利于早期治疗。方法对门诊以肥胖和智力落后就诊的6例患者,根据2001年Meral等提出的临床诊断PWS标准,将3例完全符合临床诊断标准归为高度怀疑组,另3例不完全符合临床诊断标准归为低度怀疑组。用甲基化特异性酶消化患者DNA后,同时扩增15q11．2-13位置SNRPN基因的1号外显子和内参照基因H19。结果3例高度怀疑者均确诊为PWS,均有典型PWS表现,如新生儿期严重肌张力低下,喂养困难,1岁后肌张力好转,食欲增大,肥胖,轻中度智力落后及特殊面容。另3例低度怀疑的患者有智力落后和肥胖,但无新生儿期严重肌张力低下和喂养困难者,排除了PWS诊断。结论甲基化方法结果与临床诊断吻合度高。在临床高度怀疑PWS时,建议用甲基化方法快速确诊,以使患儿能得到及时治疗。     

Prader-Willi综合征的遗传学研究进展

普拉德-威利综合征(PWS)是一种因为缺乏父源染色体15q11.2-q13区域相关基因的表达而引起的多系统受累的复杂遗传性疾病。其主要遗传机制有3种类型,即父源缺失型、母源单亲二倍体型和印记缺陷型。基于PWS的不同遗传机制可进行遗传咨询,对已生育该病患者的夫妇进行再次生育评估及产前诊断。PWS的致病原因及机制较为复杂,...     

22q11.2΢ȱʧ�ۺ���7������ٴ����ͼ��������

目的 探讨22q11.2微缺失综合征患儿的不同临床表现.方法 收集2006年7月至2007年6月在英国Oxford儿童医院临床所见的7例经分子细胞遗传学分析(FISH检测)确诊为22q11.2微缺失综合征患儿的临床资料,分析其临床表现、诊断及治疗情况.结果 7例中男2例,女5例.7例均通过FISH检测确诊,1例为产前诊断,余6例的平均确诊年龄为2个月.2例(28.4%)为父母遗传致病,5例(71.6%)为基因突变致病.其中,先天性心脏病和面容异常的发生率均为100%,免疫功能异常28.6%,颚裂14.3%,低钙14.3%.根据患儿的不同临床表现进行对症治疗.结论 22q11.2微缺失综合征患儿以心脏畸形及面容异常为突出表现,结合FISH检测可早期诊断,基因突变是其主要病因,以流出道受损为主的心脏畸形及以T淋巴细胞数量减少为主的免疫功能异常是影响预后的关键因素.     

Prader-Willi�ۺ���46���ٴ�����

??Objective??To study clinical features and diagnostic means of children with Prader-Willi syndrome??PWS?? from neonatal period to adolescence. Methods??Conduct retrospective analysis of clinical characteristics and genetic testing results of children with PWS in Children’s Hospital of Chongqing Medical University from January 2010 to January 2016. Results??Totally 46 children with PWS were chosen??28 male??18 female??the ratio of male to female being 3??2??the age of children receiving medication for the first time ranges from birth to 9 years old??the age of diagnosed children ranges from 14 days to 14 years??and the longest course of PWS had lasted for 9 years. The main clinical manifestations included hypotonia??28 cases??60%????feeding difficulties??20 cases??44%????low crying??18 cases??40%????disturbance of intelligence??42 cases??92%????obesity??25 cases??55%?? and microsomia??26 cases??57%????etc. Different ages showed different performances??newborns??0-28 days?? mainly had hypotonia??weak crying??poor suck??infants??29 days-1 year?? mainly showed backward motor development??hypotonia??weak crying??poor suck??special facial features and skin hypopigmentation etc.??babies??1-3 years?? mainly showed backward motor and intelligent development??hypotonia and skin hypopigmentation etc. Children????3 years?? mainly showed backward intelligent development??bulimia??obesity??microsomia and agenosomia??incomplete sextual development??. Among the samples??44 cases were 15q11-13 region deletion of paternal origin of the genetic material??96%????whilst 2 cases were uniparental disomy of maternal origin of the genetic material??4%??. Conclusion??As different children with PWS show different clinical manifestations??earlier genetic testing is beneficial to the early diagnosis.     

Physical features of Prader-Willi syndrome in neonates

A retrospective study of 16 patients was undertaken to identify physical features that may typify neonates with Prader-Willi syndrome. Several features known to be typical of Prader-Willi syndrome in early infancy were confirmed, including hypotonia and genital hypoplasia. A number of features that have not previously been emphasized as characterizing Prader-Willi syndrome were also identified, most notably abnormal cry and, in males, signs of genital hypoplasia but with an apparently normal phallus. Other features included disproportionately large head circumference, disproportionately large anterior fontanelle, mild micrognathia, mild anomalies of the gingivae or alveolar ridges, and changes in the appearance of the skin. Appreciation of these features may assist the pediatrician in recognizing the child with Prader-Willi syndrome during the neonatal period, before the appearance of better-known findings of later onset, such as obesity and acromicria.     

The Prader-Willi phenotype of fragile X syndrome

The Prader-Willi phenotype (PWP) of fragile X syndrome (FXS) is associated with obesity and hyperphagia similar to Prader-Willi syndrome (PWS), but without cytogenetic or methylation abnormalities at 15q11-13. Thirteen cases of PWP and FXS are reported here that were identified by obesity and hyperphagia. Delayed puberty was seen in 5 of 9 cases who had entered puberty, a small penis or testicles in seven of 13 cases, and infant hypotonia and/or a poor suck in seven of 13 cases. Autism spectrum disorder occurred in 10 of 13 cases, and autism was diagnosed in seven of 13 cases. We investigated cytoplasmic interacting FMR1 protein (CYFIP) expression, which is a protein that interacts with FMR1 protein (FMRP) because the gene for CYFIP is located at 15q11-13. CYFIP mRNA levels were significantly reduced in our patients with the PWP and FXS compared to individuals without FXS (p < .001) and also individuals with FXS without PWP (p = .03).     

The floppy infant: a practical approach

Cerebral, non paralytic and peripheral paralytic hypotonia are briefly discussed. Criteria which help in the differential diagnosis are emphasized. In the usual cerebral hypotonia, muscle strength is preserved but muscle tone is decreased. However, there are a few conditions in which cerebral hypotonia is severe enough to resemble paralytic hypotonia. These conditions include the Prader-Willi syndrome (first phase), the Zellweger syndrome and some cases of congenital myotonic dystrophy. In peripheral or paralytic hypotonia muscle weakness and hypotonia go hand-in-hand. A few practical diagnostic criteria are given which allow the differentiation between anterior horn cell disease, polyneuropathy, neonatal myasthenia and myopathy. Finally, essential or benign hypotonia is briefly alluded to.     

Neonatal hypotonia: don't forget the Prader-Willi syndrome

During the neonatal period the diagnosis of the Prader-Willi syndrome (PWS) is difficult because the syndrome is expressed mainly by severe hypotonia at this age and the typical clinical features of later life are not yet present. AIM: To identify all the PWS clinical markers in severe hypotonic newborns, which could facilitate an early diagnosis of the syndrome. METHODS: Twenty-one PWS newborns (14 males and 7 females) with severe hypotonia at birth were evaluated. Paediatricians skilled in syndromology carried out a careful clinical examination. Fluorescent in situ hybridization (FISH) analysis and/or a methylation test was used to confirm the PWS clinical diagnosis. RESULTS: The clinical diagnosis of PWS was reached at a mean age of 7.4 mo with genetic confirmation at 11 mo of life. In 12 newborns at least 3 craniofacial features were present (57%), suggesting the diagnosis of PWS. Two craniofacial dysmorphic characteristics were described in 6 newborns and only 1 in 3 cases. Cryptorchidism was monolateral in 6 and bilateral in 7 patients; in one newborn both testes were in scrotum. A micropenis was described in one patient and hypoplasia of the labia minora was reported in two females. CONCLUSIONS: Diagnosis by means of dysmorphologic evaluation is difficult in the neonatal period. The presence of severe hypotonia should always induce neonatologists to perform specific genetic tests in order to obtain an early diagnosis of PWS.     

Prader-Labhart-Willi syndrome in infants

We report an infant with severe hypotonia, feeding problems and failure to thrive in the neonatal period, followed by developmental delay. In addition, pale skin, eyelid and pedal edema, cryptorchidism and micrognathia were present. The tentative diagnosis of Prader-Labhart-Willi syndrome was made and confirmed by specific molecular testing at the age of 5 months.The Prader-Labhart-Willi syndrome is usually diagnosed in older infants when the main clinical features such as obesity, short stature, hypogonadism and developmental delay become obvious, in most of the patients typical clinical features are present already in the neonatal period. In conclusion, in neonates and young infants presenting with hypotonia and feeding problems, the Prader-Labhart-Willi syndrome should be considered.     

非免疫性胎儿水肿新生儿的临床特征及预后分析

目的 分析非免疫性胎儿水肿（NIHF）新生儿的临床特征、病因及转归情况。方法 回顾性分析23例NIHF新生儿的临床资料及转归。结果 23例NIHF患儿中,早产儿18例（78%）,足月儿5例（22%）;出生窒息12例（52%）,其中重度窒息6例。NIHF病因包括双胎输血综合征（TTTS）8例（35%）,心血管畸形3例（13%）,微小病毒B19感染3例（13%）,先天性乳糜胸2例（9%）,Turner综合征1例（4%）,柯萨奇病毒感染1例（4%）,病因不明5例（22%）。临床治愈13例（57%）,死亡10例,新生儿期病死率为43%。死亡组中早产儿、新生儿窒息、5分钟Apgar评分<8分及心力衰竭比例（分别为100%、100%、60%、60%）明显高于存活组（分别为62%、15%、8%、8%）（P < 0.05）。结论 NIHF新生儿易发生出生窒息;胎龄越小、窒息程度越重、合并心力衰竭者新生儿期死亡风险越大。TTTS中受血儿是NIHF的主要病因。     

Polymerase chain reaction in rapid diagnosis of neonatal sepsis

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.     

Prader-Willi Syndrome with del(15)(q1l, q13) Associated with Hepatoblastoma

A case of Prader-Willi syndrome who later developed hepatoblastoma is reported. Prader-Willi syndrome was suspected because of hypotonia, hypopigmentation, and undescended testes when he was a newborn infant. The diagnosis was confirmed by chromosome analysis, which showed 46XY del(15)(qll, ql3). When he was 1 year 4 months old, a liver tumor and high serum AFP were found. At operation a large tumor arising from the caudate lobe was found and the tumor was totally resected. After completion of the hepatectomy, he developed circulatory collapse of unknown cause and died shortly after the operation. Histopathologic examination revealed that the tumor was composed of two components, well differentiated cells and poorly differentiated cells. The well differentiated part did not dominate the poorly differentiated part, so it was diagnosed as poorly differentiated hepatoblastoma. This is the first reported case of Prader-Willi syndrome with a pediatric malignant tumor.