多种酰基辅酶A脱氢酶缺乏症(Ⅱ型戊二酸尿症)

戊二酸尿症是由于戊二酰酶A脱氢酶(glu-tary-COA dehydrogenaze)遗传性缺乏所引起的一种疾病,其生化表现为尿中排出戊二酸、戊烯二酸及β-羟戊二酸增加;临床表现为运动障碍及尾状核与苍白球的慢性变性。后来又报告了Ⅱ型戊二酸尿症,其生化表现为尿中大量排出戊二酸,并有α-羟     

戊二酰辅酶A脱氢酶缺乏(戊二酸尿症)时酮病的发作

戊二酰辅酶A的缺乏可以引起酮病的发作。本女对患有戊二酰辅酶A缺乏的一个七岁男孩,当嗜睡症和酮病发作时进行了详细研究。患者以肌无力及嗜睡症为其主要的临床特征;尿中的乳酸、3-羟基丁酸、戊二酸、3-羟基戊二酸、戊烯二酸、己二     

新生儿期发病的遗传代谢病的临床分析

目的通过对新生儿期发病的遗传代谢病的临床特点的归纳分析,提高儿科医生对遗传代谢病的认识,争取做到早期诊断、早期治疗。方法近3年来筛选NICU中新生儿早期原因不明的严重酸中毒、肌张力异常、吸吮和喂养困难等临床表现的遗传代谢病高危儿17例,对高危病例进行血串联质谱(MS/MS)或尿气相色谱/质谱(GC/MS)分析,同时检测血乳酸、血氨等指标,筛查遗传代谢病。结果 17例高危儿中确诊为遗传代谢病3例,分别为枫糖尿病1例,戊二酸血症1例,3-甲基巴豆酰CoA羧化酶缺乏症1例。结论熟悉新生儿期发病的遗传代谢病的临床特点,利用目前的技术方法提高早期诊断率,有利于降低围生期死亡率,避免或减轻神经系统损伤等严重后遗症的发生,促进优生优育。     

甲羟戊酸途径代谢酶HMGL研究概述

3-羟基-3-甲基戊二酰辅酶A裂解酶(HMGL)是一种参与生物体内3-羟基-3-甲基戊二酰辅酶A(HMG-CoA)代谢的重要酶类,在自然界中广泛存在,具有多种功能。作为HMGL作用的前体物质,HMG-CoA在生物体内主要有两方面作用。首先,HMG-CoA可在HMGL作用下形成酮体,酮体能够提供能量;其次,作为甲羟戊酸途径中一个重要中间体,可用于合成甾体、辅酶Q、萜类等生命活性物     

14例先天性遗传代谢病的诊治及预后分析

目的提高临床医师对遗传代谢病的认识,从而做到早诊断、早治疗。方法收集2015年3月至2016年12月在怀化地区通过新生儿串联质谱筛查、气相色谱—质谱(GC/MS)分析及高精准度DNA质谱仪联合二代测序技术(NGS)等检查确诊为先天性遗传代谢病的病人的临床资料,对他们的诊治过程及预后进行分析。结果 2015年3月至2016年12月共有确诊病人14例,分别为短链酰基辅酶A脱氢酶缺乏症3例,2-甲基丁酰辅酶A脱氢酶缺乏症2例,3-甲基巴豆酰羧化酶缺乏症2例,B-酮硫解酶缺乏症1例,Citrin蛋白缺乏症1例,原发性肉碱缺乏症1例,丙酸血症1例,戊二酸血症I型1例,高苯丙氨酸血症1例,全羧化酶合成酶缺乏症1例。对其诊治过程进行总结分析,追踪预后。结论串联质谱技术对于新生儿遗传代谢性疾病的筛查具有较高的灵敏性与特异性,有利于遗传代谢性疾病的早期筛查和诊断,值得推广和普及。     

怀化地区79205例新生儿有机酸血症筛查结果分析及随访研究

目的了解怀化市新生儿有机酸血症的发病率。方法回顾性分析怀化市2015年3月—2017年12月应用串联质谱技术进行筛查的新生儿79 205例,其中男性42 592例,女性36 613例,并对其中确诊的14例新生儿有机酸血症筛查结果及临床表现进行分析。结果在79 205例新生儿中筛查并诊断有机酸血症14例,分别为2-甲基丁酰辅酶A脱氢酶缺乏症7例,3-甲基巴豆酰羧化酶缺乏症4例,全羧化酶合成酶缺乏症1例,丙酸血症1例,戊二酸血症I型1例。结论怀化市新生儿期2-甲基丁酰辅酶A脱氢酶缺乏症最常见,其次为3-甲基巴豆酰羧化酶缺乏症、全羧化酶合成酶缺乏症,丙酸血症,戊二酸血症I型。有机酸血症患儿早期确诊有利于尽早有效的治疗,改善预后,提高出生人口素质。     

他汀类药物的免疫调节及神经保护作用机制

他汀类药物是羟甲基戊二酸单酰辅酶A还原酶的抑制剂,临床上主要用于高胆固醇血症的治疗.近年研究发现,他汀类药物具有抑制促炎性细胞因子(Th1和Th17细胞冈子)的分泌、增加调节性T细胞(Treg)数量和功能、抑制树突状细胞(DC)成熟等作用.通过这些免疫调节和抗炎作用,他汀类药物在神经系统疾病如脑卒中、阿尔茨海默病(AD...     

BSCL2突变致先天性全身性脂肪营养不良伴严重中枢神经系统受累1例

目的分析1例BSCL2突变所致先天性全身性脂肪营养不良(CGL)2型合并中枢神经系统受累患者的临床特点及基因型,提高对该病神经系统受累的认识。方法总结患儿的病史、临床表现、实验室检查结果并进行分析,抽取患者及父母外周静脉血,提取基因组DNA进行第二代基因测序,并对患者治疗及随访。结果患儿临床表现为全身皮下脂肪消失、肝大、黑棘皮征、发育迟滞、癫痫发作、共济失调、认知功能倒退。血转氨酶、三酰甘油(TAG)、空腹胰岛素水平升高。脑电图(EEG)监测到多种发作。第二代基因测序显示患儿的BSCL2存在c.782dupG碱基重复纯合突变,为致病突变,父母均携带c.782dupG碱基重复杂合变异。饮食控制及口服二甲双胍,血TAG及胰岛素水平无改善。口服拉莫三嗪控制癫痫效果不佳,神经系统症状加重。结论 BSCL2突变导致的CGL2,除典型脂肪营养不良表现,还可有严重神经系统受累,预后不良。     

应用串联质谱技术进行新生儿遗传代谢病筛查43005例结果分析

目的探讨串联质谱技术在怀化地区新生儿遗传代谢病筛查中的应用,了解怀化地区新生儿遗传代谢病的发病率和基因突变情况。方法应用串联质谱技术对2015年3月~2016年12月怀化地区43 005例新生儿进行遗传代谢病筛查,初筛阳性者立即召回复查,复查阳性者应用气相色谱-质谱分析尿中的有机酸、氨基酸、肉碱等代谢产物,并且应用高精准度DNA质谱仪联合二代测序技术(NGS)检测阳性患儿的突变基因。结果 43 005例新生儿中初筛阳性854例,阳性率1.99%。确诊患儿14例,B-酮硫解酶缺乏症1例,2-甲基丁酰辅酶A脱氢酶缺乏症2例,希特林蛋白缺乏症1例,短链酰基辅酶A脱氢酶缺乏症3例,原发性肉碱缺乏症1例,丙酸血症1例,戊二酸血症I型1例,高苯丙氨酸血症1例,3-甲基巴豆酰羧化酶缺乏症2例,全羧化酶合成酶缺乏症1例。发病率分别是1/43005、1/21503、1/43005、1/14335、1/43005、1/43005、1/43005、1/43005、1/21503、1/43005。结论串联质谱技术在新生儿遗传代谢病筛查中可以更有效、更早地确诊这些遗传代谢病,为针对性治疗提供有效依据,为遗传代谢病的筛查开辟了新的领域。     

戊二酸尿症-Ⅰ型三例诊断分析及文献复习

目的探讨戊二酸尿症1型的临床特征和诊断思路。方法对3例戊二酸尿症1型患儿的临床资料进行分析。结果3例患儿均表现为感染或惊厥后发育倒退,其中大头畸形一例,不明原因的硬膜下积液一例。结论戊二酸尿症1型临床表现无特异性,但感染或惊厥后发育倒退、大头畸形、不明原因的硬膜下积液时是其主要特征,尿有机酸分析是诊断的重要依据。     

Citrobacter freundii infection in glutaric aciduria type 1: adding insult to injury

Glutaric aciduria type 1 (GA1) is an inborn error of organic acid metabolism, where the brain is the principal organ affected with exposure to toxic metabolic product, 3-hydroxyglutaric acid (3-OHGA). A 2-year-old boy with GA1 and delayed developmental milestones had an acute neurological crisis leading to massive brain abscess with Citrobacter freundi infection, a rare cause of neonatal meningitis and often associated with brain abscess. Both 3-OHGA and C. freundii can damage the blood-brain barrier and can cause significant trauma which demands immediate and appropriate management. Encephalopathic manifestations of GA1 may consequently increase the risk of meningeal infection and it has not been previously documented.     

Abnormalities in cholesterol metabolism cause peripheral neuropathy and dementia in AIDS--a hypothesis

The AIDS dementia complex and peripheral neuropathy in AIDS are considered to be direct or indirect manifestations of HIV infection, yet the pathogenesis in unclear. There are parallels between AIDS and Tangier disease clinically and histopathologically and in lipid metabolism. The neurological disorders in AIDS may be caused by dysfunction of cellular cholesterol transport. Substitution of high density lipoprotein is recommended in the treatment of severe polyneuropathy and dementia in AIDS.     

Adropin 蛋白在多囊卵巢综合征中的研究进展及临床意义

多囊卵巢综合征 (polycystic ovary syndrome, PCOS) 是一种在育龄期女性中常见的疾病, 它的主 要临床表现是月经紊乱、 不孕、 痤疮、 多毛等症状, 可能伴随有糖脂代谢异常。 Adropin 是新近发现的一种 分泌性蛋白, 已证实其在调节糖脂代谢、 改善胰岛素抵抗中发挥着作用, 但具体作用机制及其临床意义尚 未完全明确。 文章简要综述 Adropin 蛋白的作用机理及其在多囊卵巢综合征中的研究进展及临床意义。     

Glatiramer acetate could be a potential therapeutic agent for Parkinson's disease through its neuroprotective and anti-inflammatory effects

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. The hallmark pathologic feature of PD is dopamine deficiency, caused by the degeneration of nigrostriatal dopaminergic neurons. Current treatments for PD mainly address the dopaminergic features of the disease; however they do not modify the progression of neurodegeneration. The need for newer and more effective agents is consequently receiving a great deal of attention. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, can promote survival of injured dopaminergic nigrostriatal neurons in the rodent. Postmortem studies have suggested that BDNF deficiency may play a role in PD pathogenesis. This is further supported by the finding that BDNF administration has a therapeutic effect in animal models of PD. Glatiramer acetate (GA) is a collection of synthetic polypeptides approved for the treatment of relapsing-remitting multiple sclerosis. Preclinical studies have demonstrated that peripheral GA administration can enhance central BDNF activity and augment neurogenesis. Furthermore, PD has been associated with an inflammatory process in the brain. Animal studies have demonstrated that GA administration has a central anti-inflammatory effect through the release of anti-inflammatory cytokines. From the above evidence, GA could act as a potential therapeutic agent for PD by increasing central BDNF and by exerting an anti-inflammatory effect. With the recent finding that GA administration can prevent neuronal loss and cognitive decline in Alzheimer's disease double-transgenic mice, early GA treatment may also prevent neurodegeneration and manifestations of PD symptoms in subjects with familial Parkinson's disease.     

Cancer as a systemic disease

Theories on the nature of cancer may be classified into two categories. One regards cancer strictly as a local phenomenon while the second looks at cancer as a local manifestation of a systemic process or disease. Although the first dominates current medical thought, the theories of immunological surveillance and of protovirus-oncogene implicitly assume cancer to represent a local manifestation of a systemic process or disease. This is supported also by epidemiological data forwarded in the present paper. In order to clarify the exact meaning of a systemic disease, cancer and its manifestation are compared with arteriosclerosis and its sequelae. Arteriosclerosis could be regarded as a prototype of a systemic disease. It presents itself clinically solely by its local manifestations, like myocardial infarction or stroke. These local manifestations may be followed by secondary systemic sequelae like congestive heart failure. In the same context, it is proposed to regard cancer as one systemic disease which presents it-self clinically by local phenomena like carcinoma, lymphoma and sarcoma. These local manifestations may lead further to secondary systemic sequelae like metastasis.     

Glatiramer acetate treatment does not modify the clinical course of (NZB x BXSB)F1 lupus murine model

Glatiramer acetate (GA, copolymer-1, Copaxone), a therapy approved for treatment of multiple sclerosis (MS), prevents and reverses experimental autoimmune encephalomyelitis, the animal model of MS. In central nervous system autoimmune disease, GA is thought to act through modulation of antigen-presenting cells, such as monocytes, mediating an antigen-independent T(h)2 shift and development of FoxP3+ regulatory T cells. Recent reports indicate that GA may also be effective in models of other autoimmune diseases such as uveoretinitis, inflammatory bowel disease and graft rejection. To date, the potential effect of GA in lupus animal models has not been described. (NZB x BXSB)F1, male mice bearing Y-linked autoimmune acceleration , is a lupus-prone mouse model which is associated with a monocytosis accelerating disease progression. These mice were treated with GA before disease onset until death and both mortality rate and biological parameters were assessed to investigate whether GA may be beneficial in this spontaneous model of systemic lupus erythematosus. GA exerted no beneficial effect on the median survival after up to 7 months of treatment. Humoral and cellular parameters used as markers for lupus progression, such as anti-chromatin, anti-double-stranded DNA and anti-erythrocytes antibodies, hematocrit and monocytosis, were similarly unchanged. Our study demonstrates that GA has no significant effect on the progression of the (NZB x BXSB)F1 lupus-prone animal model. These results reinforce the hypothesis that GA may exert its beneficial effect in some specific autoimmune diseases only.     

Hepatitic inherited metabolic disorders

Primary metabolic disorders are a disparate group of diseases that may or may not be accompanied by hepatic manifestations. Those with liver involvement may show a range of histopathologic changes. Proper histologic diagnosis requires correlation with clinical and laboratory data, including evaluation for mutations either via serum protein electrophoresis or through formal genetic analysis. This article is a review of the three most common inherited metabolic disorders which may present with a hepatitic pattern. In alpha1-antitrypsin disorder, there is a broad range of clinical presentations, age at presentation, and histological features ranging from "neonatal hepatitis" to a chronic progressive hepatitis in later childhood and adulthood. Hence, this disorder must be in the differential diagnosis of liver disease of the very young, and in older children and adults, with or without coexistent overt pulmonary symptoms. In Wilson disease, presentation tends to be in older childhood or the adult, with a progressive chronic hepatitis. Cystic fibrosis may feature a characteristic obstructive biliary syndrome, coexisting with the many extrahepatic manifestations of this debilitating disease. Lastly, the progressive familial intrahepatic cholestasis (PFIC) syndromes are given as examples of inherited metabolic conditions in which relentlessly progressive cholestatic liver disease eventuates over years in end-stage cholestatic liver disease with cirrhosis. Distinguishing features include absence of elevated serum gamma-glutamyl transpeptidase (GGT) in PFIC-1 and PFIC-2, and elevated GGT in PFIC-3. However, molecular studies are required for a confident diagnosis of the rare PFIC syndromes.     

Ichthyosis and neutral lipid storage disease

Four members of a consanguineous middle eastern family had a lipid storage disease characterized by congenital ichthyosiform erythroderma, neurosensory deafness, cataracts, mild myopathy, and leukocyte vacuoles. These patients are similar to several others recently reported and represent a unique disorder of lipid metabolism. The clinical and biochemical manifestations of this lipid storage disease are reviewed. Evidence is presented that the disorder is inherited as an autosomal recessive trait, and that heterozygotes may be detected by the presence of vacuoles within circulating eosinophils.     

Hepatosteatosis with hypobetalipoproteinemia

Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to chronic liver disease. Most cases of fatty liver are asymptomatic and often are detected during routine medical or laboratory examinations. There also are some rare genetic diseases such as abetalipoproteinemia and familial hypobetalipoproteinemia that may cause fatty liver disease. Both are inherited disorders of lipoprotein metabolism. Although abetalipoproteinemia and homozygous familial hypobetalipoproteinemia patients present with severe manifestations, heterozygotes are usually asymptomatic. In the last several years, case reports or studies indicating a relationship between hepatosteatosis and familial heterozygote hypobetalipoproteinemia (FHBL) have been reported. Here, we report three cases of FHBL with characteristic lipid profile, mildly elevated liver enzymes and hepatosteatosis confirmed by ultrasonography.     

The therapeutic effect of glatiramer acetate in a murine model of inflammatory bowel disease is mediated by anti-inflammatory T-cells

Inflammatory bowel diseases (IBDs) are complex multifactorial immunological disorders characterized by dysregulated immune reactivity in the gut and imbalance between pro-inflammatory and anti-inflammatory reactivity. The therapeutic effect of the immunomodulatory drug glatiramer acetate (GA, Copaxone, copolymer 1) has been established in several IBD models, including trinitrobenzene sulfonic acid (TNBS) and dextran sulfate sodium (DSS)-induced colitis, as well as in a spontaneous colitis model. In the present study we investigated the mechanism of action of GA and cells specifically induced by it. Immunization of naive mice by GA, generated a lymphocyte population of the Th2/3 subtype, that drastically reduced disease manifestations upon their adoptive transfer to mice with DSS colitis. This was demonstrated by the substantial decrease in weight loss, intestinal bleeding and diarrhea, as well as by the prevention of macroscopic and microscopic colonic damage. In contrast, adoptive transfer of control lysozyme-specific cells did not induce any beneficial effect on the disease. Moreover, GA-specific short-term T-cell lines, either exogenously labeled or genetically marked, adoptively transferred by the intraperitoneal route to colitis-induced mice, localized in the inner layers of the colon and secreted in situ the regulatory cytokine TGF-beta. These results demonstrate the accumulation of GA-specific Th2/3 cells secreting regulatory cytokines in the injured colon, and thus draw a direct linkage between the therapeutic effect of GA in IBD and an immunomodulatory effect at the site in which the pathological process occurs.