染色体 1p32-p31 缺失综合征 1 例报告并文献复习

目的探讨染色体1p32-p31缺失综合征的的临床特征。方法回顾分析1例染色体1p32-p31缺失综合征患儿的临床资料,并复习相关文献。结果患儿,男,6个月,出生胎龄39~(+2)周,出生体质量2.2 kg,出生时有轻度窒息,生后发育落后。患儿面容特殊,前额及后枕突出、眼距宽、眼裂小、双侧耳位低、低鼻梁、小鼻、唇薄、下颌小、高腭弓,右侧睾丸未降至阴囊,左侧阴囊积液,手指、足趾短小,四肢肌张力稍低。Gesell发育量表评估发育商46。头颅MRI示脑白质比例偏少,双侧侧脑室增宽,胼胝体后部纤细。脑电图示清醒背景较同龄儿略慢。脑干听觉诱发电位示左侧反应阈65 dB,右侧反应阈40 dB。高通量DNA测序发现患儿1p32.3-p31.3区域(chr1:54560001-66400000,hg19)存在缺失,缺失片段大小为11.84 Mb,包含NFIA基因在内的多个基因。确诊为染色体1p32-p31缺失综合征。结论染色体1p32-p31缺失综合征的临床特征包括胼胝体发育不良、脑室扩大/脑积水、巨头、特殊面容、不同程度发育迟缓,部分伴泌尿系统异常。NFIA基因是导致该病的关键基因。     

6号环状染色体致隐匿性阴茎1例报告及文献复习

目的探讨6号环状染色体片段缺失与临床表型的关系。方法报道1例因隐匿性阴茎就诊男性患儿,通过常规染色体核型和全基因组染色体微阵列芯片技术,分析缺失片段位置及包含基因与临床表型的关系;同时进行文献复习。结果患儿染色体核型分析结果为6号环状染色体,全基因组染色体微阵列芯片检测发现,6号染色体短臂和长臂末端均存在缺失,del6p25.3p25.1.seq[GRCh37/hg39](204909-4210858)×1,del6q27.seq[GRCh37/hg39](170438227-170898549)×1,短臂p25区域缺失4.01 Mb,包含DUSP22、IRF4、EXOC2、HUS1B、LOC285768、FOXQ1、FOXF2、FOXC1等30个基因,而长臂6q27区域发生0.46 Mb缺失,包含LOC154449、DLL1、FAM120B、PSMB1、TBP、PDCD2等7个基因。分析比较本例患儿和文献报道的6号环状染色体病例,发现所有患儿均存在神经或生长发育障碍,但仅本例和另1例患儿有生殖道畸形。结论 6号环状染色体患者的临床表型与染色体缺失部位、缺失片段大小以及环状染色体稳定性密切相关。     

WoIf-Hirschhorn综合征11例临床分析

目的探讨Wolf-Hirschhorn综合征(WHS)的临床表现、遗传学特征、治疗及预后等。方法回顾分析2009年6月-2018年6月诊治的11例WHS患儿的临床资料。结果符合WHS染色体改变诊断标准者15例,其中男6例、女9例,就诊年龄中位数为4月龄。15例患儿的染色体检测均有4p结构畸变,主要为单纯4p缺失(46.6%),其他还存在臂间倒位、重复或插入、衍生染色体、环状染色体。其中3例进一步行基因检测确认缺失片段大小。15例中11例资料完整,临床表现明确。首诊原因包括癫痫5例,生后反应差、低体质量5例,肺炎1例。主要核心临床表现为生长/精神发育迟缓、癫痫、希腊武士头盔面容,还可能存在多系统异常。3例在1岁内因肺炎/惊厥死亡,存活者均存在严重智力运动发育落后。结论WHS为4号染色体的结构畸变,4p16.3上的关键基因缺失,导致生长/精神发育迟缓、癫痫、特殊面容、多系统异常,预后较差。     

20p12.2缺失致Alagille综合征患儿临床和肝脏病理分析

目的分析20p12缺失致Alagille综合征(ALGS)患儿的临床表现和肝脏病理。方法回顾分析1例20p12微缺失致ALGS患儿的临床资料。结果患儿,男,1月龄起病,以胆汁淤积为首发表现,伴特殊面容,蝶形椎,肾脏和心脏病变;肝脏穿刺术病理学检测提示肝脏淤胆改变,肝细胞中度损害(G2S3),无胆管减少表现。采集患儿及父母血标本,采用二代基因测序检测发现chr20p12.2:(9288462-10654178)处1.36 Mb的杂合缺失,缺失片段中包含JAG1基因,为新发突变。确诊后予以对症支持治疗,随访半年,患儿生长发育无异常,黄疸仍迁延不退,远期预后有待进一步随访。结论ALGS是一种常染色体显性遗传病,临床表现多样,基因检测和肝活检有助于诊断。     

AHDC1基因突变致Xia-Gibbs综合征1例报告并文献复习

目的探讨AHDC1基因突变致Xia-Gibbs综合征的临床表现、基因变异特点。方法回顾分析2018年12月接诊的1例AHDC1基因突变致Xia-Gibbs综合征患儿的临床资料,并结合文献分析Xia-Gibbs综合征患儿的临床表现、基因突变特点。结果男性患儿,5岁7月,以全面发育落后、面容特殊,耳位低,拇指内收为主要表现;头颅CT示双侧小脑半球后外方脑外间隙增宽、蛛网膜囊肿。学龄前儿童韦克斯勒氏智能测试提示智商重度低下。全外显子检测发现AHDC1基因新发剪切突变c.3185_c.3186delCA,导致蛋白编码提前终止(p.T1062Sfs*63),确诊为Xia-Gibbs综合征。检索万方数据库,检出中文文献1篇;检索PubMed及Medline,检出英文文献16篇;合并该患儿共35例Xia-Gibbs综合征患儿,其中34例为AHDC1基因新发突变,1例为包含AHDC1基因在内的染色体微缺失所致。结论 Xia-Gibbs综合征是由AHDC1基因新发突变所致神经系统疾病,其突变位点及临床表现的特异性目前尚无定论,二者的相关性有待进一步研究。     

16p11.2缺失综合征1例并文献复习

目的 提高对16p11.2缺失综合征的临床和基因特征的认识。方法 总结分析1例16p11.2缺失综合征患儿的临床发现、辅助检查、诊断和随访资料,并文献复习。结果 ①患儿,男,2月13 d,因“发热近20 d伴咳嗽、腹泻”起病。入院查体可见右手六指畸形,脊柱侧弯,外周血淋巴细胞及其亚群明显低于正常同龄儿。X线胸片示胸椎9～12部分椎体呈半椎体畸形,胸骨塑形异常。予抗感染等治疗后好转,并呈多动兴奋表现。出院后随访提示淋巴细胞数量较住院时好转,但WBC、中性粒细胞及CD4+T细胞均低于正常值。患儿5月龄时诊断癫,予抗癫药物治疗有效。应用染色体芯片检测技术,并采用高密度寡核苷酸微阵列比较基因组杂交技术证实16p11.2区域缺失,缺失片段大小约0.545 4 Mb,该区段所包含的基因有SPN、QPRT、 C16orf54、 KIF22、 MAZ、 SEZ6L2、 CDIPT、 ASPHD1、 KCTD13、TMEM219、 TAOK2、 DOC2A、TBX6等;患儿父母染色体芯片检查结果均未发现异常。确诊为16p11.2缺失综合征。②检索国内外报道的关于16p11.2缺失相关病例共1 378例,临床表型涉及到神经系统表现547例（39.7%）,内分泌系统371例（26.9%）,生长发育与骨骼异常84例（6.1%）,泌尿生殖与消化系统10例（0.7%）,心血管系统4例（0.3%）,免疫功能异常1例（0.07%）,由于缺失片段大小不一,导致临床表型具有较大的异质性。结论 多发骨骼畸形（尤其脊柱侧弯）,伴神经系统异常（如癫痫、孤独症等）,其他系统累及（如反复感染、内分泌异常等）应考虑16p11.2缺失综合征可能,通过染色体芯片检测技术以及高密度寡核苷酸微阵列比较基因组杂交技术帮助诊断。     

Mowat-Wilson 综合征2 例临床及遗传学分析

目的探讨Mowat-Wilson综合征(MWS)患儿的临床表型及遗传学特点。方法回顾分析2例MWS患儿的临床资料。结果男女患儿各1例,女性患儿3岁、男性患儿1岁4月龄,均以全面发育迟缓就诊。患儿面容异常,前额突出,眼距宽;语言、运动发育落后;均存在肌张力低下、心脏畸形以及泌尿生殖系统畸形。头颅磁共振成像示胼胝体发育不良。女性患儿脑电图异常,但未出现癫痫。女性患儿染色体芯片检测示染色体2q22.3区域存在缺失,大小为1.95 Mb,该区域包括ZEB2整个基因;定量PCR证实患儿该区域为新发变异。男性患儿高通量测序及Sanger测序验证发现ZEB2基因存在IVS1-2AG剪接位点杂合突变。结论 MWS的主要临床表现为面容异常、语言运动发育落后、多发畸形、胼胝体发育不良等,分子生物学检测有助于临床确诊。     

Alagille综合征患儿1例临床和遗传学分析:一个包含JAG1基因的染色体新中间缺失的识别

Alagille综合征(ALGS)是一种常染色体显性遗传病,可累及肝脏、心脏、骨骼、眼睛、肾脏、颜面等多个系统。本文报道1例ALGS患儿的临床和遗传学特征。患儿为3个月10d男婴,因发现皮肤、巩膜黄染3个月就诊。体格检查示:宽额头,小下颌;胸骨左缘第2、3肋间可闻及3~4/6级收缩期杂音;腹部膨隆,肝右肋下3cm可触及,质地中等。生化结果示肝功能明显异常,胆红素升高,且以结合胆红素升高为主,伴总胆汁酸和γ-谷氨酰转肽酶显著升高。心脏彩超示房间隔缺损、肺动脉狭窄。二代测序发现该患儿JAG1基因整体杂合缺失,而染色体微阵列分析在患儿20号染色体p12.3p12.2处检出约3.0Mb缺失,该范围包含ALGS致病基因JAG1。该患儿具备特殊面容、心脏畸形和胆汁淤积等临床表现,结合遗传学分析结果,诊断ALGS明确。确诊后给予对症支持治疗,现已随访至生后11个月,胆红素较治疗前明显下降,但总胆汁酸和γ-谷氨酰转肽酶等指标仍明显升高,其远期预后仍有待随访观察。本研究扩展了JAG1基因突变谱,同时为患儿诊断、治疗及家系遗传咨询和产前诊断提供了实验室依据。     

Currarino综合征2例临床与遗传学分析北大核心CSCD

目的探讨Currarino综合征患者的临床表现及运动神经元与胰腺同源框基因（motor neuron and pancrea shomeobox 1 gene,MNXl基因）突变的特点。方法利用染色体芯片技术对Currarino综合征患者进行全基因组水平微缺失／微重复检测,并复习文献比较相似基因型Currarino综合征患者的临床表型。结果纳入2例Currarino综合征患者。例1,女,7d,因“反复呕吐”就诊,入院查体发现患者面容特殊,足月小样儿,视不追物,腹部胀气严重;患儿肛门狭窄,肠道造影提示中肠旋转不良;心脏彩超提示卵圆孔未闭或房间隔缺损;头颅超声提示颅内出血,骶尾椎磁共振成像（MRI）示脊髓栓系,骶尾椎发育畸形;染色体芯片技术检测发现7号染色体q36．1q36．3区域缺失1个拷贝（7．89Mb）,14q32．33区域重复1个拷贝（2．20Mb）;患儿父母该区域未见异常。例2,女,1岁3个月,因“整体发育落后”就诊;患儿面容特殊,右眼上睑下垂,语言、运动均落后,肛门狭窄,MRI示隐性脊柱裂;染色体芯片技术检测发现7号染色体q35q36．3区域缺失1个拷贝（15．00Mb）。文献复习：MNXl基因所在的染色体区域缺失导致的Currarino综合征存在特殊面容、智力障碍及生长落后的特征,国内未见该类型的报道。结论在国内首次报道了2例因染色体微缺失导致的Currarino综合征,丰富了临床医师对该病的认识。     

22q11.2微缺失综合征的分子诊断及缺失范围检测

目的 分别采用多重连接探针扩增技术(MLPA)与荧光原位杂交技术(FISH)对22q1 1.2微缺失综合征外周血标本患者基因缺失/重复突变的类型及变异范围进行检测,分析在22q11.2微缺失综合征诊断中二者联合应用的诊断价值.方法 采集1例仅心脏异常患儿及其父母外周血,取200 μL外周血提取DNA后采用MLPA技术对患儿及其父母的染色体22q11.2缺失的范围进行检测,取外周血1 mL进行培养,采用DiGeorge/VCFS N25(D22S75)的FISH探针对培养后的中期淋巴细胞进行杂交.结果 患儿淋巴细胞分裂中期细胞应用FISH技术检测结果为22号染色体上的DiGeorge/VCFS N25(D22S75)区杂合性缺失;MLPA验证结果显示患儿与22q11.2微缺失综合征相关的6个探针对应的片段大小位置在3100的电泳图上荧光峰值相比健康对照明显出现减半,其父母亲均在正常范围.患儿的临床表现仅有先天性心脏病,无其他异常,与其基因缺失片段长度(2.0 Mb)极不相称.结论 联合应用FISH和MLPA检测22q11.2微缺失综合征,可以明显提高诊断的准确性.22q11.2微缺失综合征的临床表现与基因缺失片段的长度无相关性.     

Noonan syndrome and its related disorders

The diagnosis of Noonan syndrome still rests on its clinical features. There are several syndromes to consider in the diagnosis of Noonan syndrome. These include cardio-facial-cutaneous syndrome, LEOPARD syndrome, neurofibromatosis-Noonan syndrome and Costello syndrome. The facial appearance and part of the clinical features of these syndromes are very similar to Noonan syndrome. Molecular research likely will elucidate whether these syndromes are variations of Noonan syndrome or etiologically different disorders.     

48,XXYY, 48,XXXY and 49,XXXXY syndromes: not just variants of Klinefelter syndrome

Sex chromosome tetrasomy and pentasomy conditions occur in 1:18,000-1:100,000 male births. While often compared with 47,XXY/Klinefelter syndrome because of shared features including tall stature and hypergonadotropic hypogonadism, 48,XXYY, 48,XXXY and 49,XXXXY syndromes are associated with additional physical findings, congenital malformations, medical problems and psychological features. While the spectrum of cognitive abilities extends much higher than originally described, developmental delays, cognitive impairments and behavioural disorders are common and require strong treatment plans. Future research should focus on genotype-phenotype relationships and the development of evidence-based treatments. CONCLUSION: The more complex physical, medical and psychological phenotypes of 48,XXYY, 48,XXXY and 49,XXXXY syndromes make distinction from 47,XXY important; however, all of these conditions share features of hypergonadotropic hypogonadism and the need for increased awareness, biomedical research and the development of evidence-based treatments.     

Cardiac problems in genetic syndromes

Congenital heart disease affects around 0.7% of liveborn infants and is the most frequent cause of death from congenital malformations. This review will consider some of the commoner genetic syndromes associated with congenital heart disease, the spectrum of cardiac defects observed in them and the associated features and comorbidities that may impact on the outcomes of cardiac surgery.     

Kabuki make-up syndrome

Kabuki make-up syndrome is a rare disorder characterized by mental retardation, postnatal dwarfism and peculiar facies. This condition is believed to be common in Japan, but has been reported from other parts of the world. The authors report a case of this syndrome in an eight-year-old girl, with the characteristic findings from India.     

Laurence-Moon-Biedl syndrome (?) and Prader-Willi syndrome (?) in a single family

Mental retardation, hypogonadism, obesity, and abnormal blood sugar regulation were common findings in two siblings. In addition, the 17-year-old female patient showed short stature, muscular hypotonia in infancy, and small hands with tapering fingers suggesting Prader-Willi syndrome, and the 12-year-old male patient showed retinitis pigmentosa, normal height, and normal muscular tonicity suggesting Laurence-Moon-Biedl syndrome, though polydactyly was absent. Possible consideration was discussed.     

Acute Febrile Neutrophilic Dermatosis (Sweet's Syndrome) in Myelodysplastic Syndrome

This is the first report of the rare association of acute febrile neutrophilic dermatosis (Sweet's syndrome) and myelodysplastic syndrome (MDS) in a child. The skin lesions showed a dramatic response to colchicine.     

Co-existence of Dubowitz and hyper-IgE syndromes: A case report

A case of a 5-year-old girl is described whose clinical features included postnatal growth retardation, microcephaly and characteristic facial appearance. These are recognized as the main features of the Dubowitz syndrome. Apart from these features, our patient had recurrent infections of the sinopulmonary tract, high serum IgE levels, defective chemotaxis of polymorphonuclear cells and defective antibody response, findings characterizing the hyper-IgE syndrome. The co-existence of these two syndromes is rare and we suggest that this is the first such case in the literature.Conclusion Patients with the Dubowitz syndrome will require long-term follow up because there is a considerable risk for the syndrome to co-exist with primary immunodeficiency or formalignancies to develop.     

Campomelic Syndrome Associated with Potter's Syndrome and Car diosplenic Syndrome

ABSTRACT Campomelic syndrome is a heterogeneous group of disorders characterized by short-limbed dwarfism with congenital bowing or bending of the long bones particularly in the lower limbs and is frequently associated with a variety of non-skeletal manifestations. Two distinct types are (1) long-limbed campomelic dysplasia with bent bones of normal length and width: (2) short-limbed campomelic dysplasia in which the bent bones are short and wide. We reported an autopsy case of this syndrome.
This male baby with gestational age of 32 weeks was born to a mother with placenta previa, showing abdominal distention and short-limbed appearance. Postmortem examination revealed bilaterally enlarged Potter type 1 polycystic kidneys, a pancreatic cyst, and two spleens in the abdominal cavity. Both lungs were hypoplastic and the heart exhibited multiple congenital anomalies such as double outlet right ventricle, pulmonary artery hy-poplasia, mitral atresia, absence of ductus arteriosus, and inferior vena cava draining into the left atrium. Characteristically both femur bones were curved at proximal two-thirds with slightly shortened lengths. Both humeri also showed bending of distal one-third. Other chondro-osseous abnormalities such as small epiglottis, narrow thorax, dolichoce-phaly, and bilateral equinovarus deformity were noted. These findings were compatible with campomelic dysplasia of long-limbed type accompanying unusual sets of non-skeletal manifestations of Potter's syndrome and cardiosplenic syndrome. Key words: campomelic syndrome, Potter's syndrome, cardiosplenic syndrome     

A patient with features of both Bardet-Biedl and Alström syndromes

We describe a 30-year-old patient with acanthosis nigricans, diabetes mellitus with insulin resistance, hypogonadotropic hypogonadism, pigmentary degeneration of the retina and cerebellar, pyramidal and posteri-or columnar involvement. He had normal mental function, normal hearing and no hexadactyly. The patient had symptoms of both Bardet-Biedl and Alström syndromes, but did not manifest all the main features of either syndrome. This suggests either that the Bardet-Biedl, Alström, Laurence-Moon syndromes (including the variant described by Edwards) have a highly variable expression or that our case is a new variant within this group of syndromes.