体细胞突变与染色体断裂综合征的临床研究

临床病例 病例1:女,26岁,不全流产查因,核型为46,XX/45,XX,-18,(2/60)/46,XX,d el(18)(pter→p11q11qter)(2/60); 病例2:男,24岁,妻难免流产,核型为46,XY/45,XY,-22,(2/60)/46,XY,-22, mar; 病例3:女,25岁,孕3产0,自然流产1次,死胎2次(均在5-6个月),核型为46,XX,/46,X X,del(2)(pter→p12),(2/60)/45,X(2/60); 病例4:男,27岁,表型正常,妻生育一胎21三体,核型为46,XY/46,XY,b(16)(q22:)( 14/30);妻子核型正常. 病例5:例4之女,核型为46,XX, 21,rob(21;21),b(16)(q22:) mar.     

无创产前筛查技术筛查胎儿性染色体变异的效能评价

目的探讨无创产前筛查(non-invasive prenatal screening,NIPS)技术对胎儿性染色体变异的筛查效能,为临床实践提供理论依据。方法回顾性分析福建省接受NIPS筛查的孕妇20802例,提示性染色体变异165例,收集其侵入性产前诊断结果,比较检测结果的符合情况。结果20802名孕妇NIPS提示性染色体异常165例,接受介入性产前诊断129例,检测出性染色体变异45例,阳性预测值为34.88%(45/129),包括16例47,XYY、10例47,XXY、6例45X/46,XX、5例47,XXX、3例45,X,以及45,X/46,X,i(X)(q10)、45,X/46,X,del(X)(q22)、46,X,del(X)(q22)、46,X,del(X)(p11)和Xp22.31缺失1.2 Mb各1例。结论NIPS对性染色体变异的筛查效能有限,介入性产前诊断中核型分析结合其他诊断技术可以有效避免漏诊。     

额外小标记染色体患者的细胞遗传学检测

目的报告9例额外小标记染色体(s SMC)病例,结合文献分析s SMC的特点及临床意义。方法应用外周血淋巴细胞培养、染色体G显带技术对5110例遗传咨询病人进行染色体核型分析。结果发现9例s SMC患者,其中47,XY,+mar 3例,47,XX,+mar 3例,45,X/46,X,+mar 2例,48,XY,+2mar 1例。结论 s SMC具有染色体来源和表型的异质性,G显带核型分析结合多种分子遗传学检测技术可对其进行鉴定。     

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。     

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。     

生育能力异常的人群染色体多态性及畸变临床数据分析

目的报告本科室生育能力异常人群的染色体多态性及畸变检出率的结果。方法回顾性分析从2010年1月—2015年12月就诊于安徽医科大学第一附属医院生殖中心生育功能异常(包括不孕不育、少弱畸精子症、胚停、复发性流产及胎儿畸形等)的8084例患者,于我中心行外周血细胞遗传学G显带染色体核型分析的检查结果。结果 8084例生育功能异常患者中,检出染色体变异核型1329例,占比16.43%。其中包括染色体多态性1009例,占比12.48%(1009/8084),染色体多态性的患者中,染色体长臂次缢痕qh+患者749例(包括1qh+、9qh+、16qh+共545例,Yqh+共210例),D/G组染色体短臂及随体多态性变异160例,9号染色体臂间倒位75例,46,XY,inv(y)3例,其他染色体(非9号及Y染色体)臂间倒位14例,小Y共2例。检及异常核型的染色体共320例,占比3.96%(320/8084),其中染色体易位患者186例(含罗氏易位40例,染色体相互易位145例);嵌合体12例;46,X,i(X)4例;46,X,del(X)3例;46,X,del(Y)2例;45,XO有7例;47,XN,+21检出5例;47,XXX 8例;47,XXY 55例;47,XYY 7例;47,XY,+mar4例;48,XY,+mar,+mar 1例;其他较少见异常核型27例。结论人类染色体多态性及畸变与人类生育能力异常(不孕不育、少弱畸精子症、胚停、复发性流产及胎儿畸形)等可能存在相关性。     

51例Turner综合征患者染色体核型分析及临床特征

目的探讨Turner综合征不同核型的遗传学特征、临床特点及其所占比例。方法无菌取患者外周血,淋巴细胞常规培养制作染色体标本,胰酶法G显带,显微镜下进行染色体核型分析。结果 51例Turner综合征患者的染色体核型为:45,XO 19例(37.56%),45,XO/46,XX 9例(17.65%),46,Xi(Xq)8例(15.69%),45,XO/46,Xi(Xq)5例(9.8%),47,XXX 3例(5.88%),45,XO/46,X+mar 2例(3.92%),45,XO/46,XY 2例(3.92%),45,XO/45,i(Xq)2例(3.92%),46,X,del(X)(qter→q11:)1例(1.96%)。结论 Turner综合征患者的染色体有数目异常和结构畸变等多种核型,均可不同程度导致女性闭经、性腺发育异常及智力低下等症状,应提倡优生优育,做好产前诊断。     

定量荧光多重PCR快速诊断21-三体

目的 探讨多重定量荧光PCR(QF-PCR)技术在快速诊断21-三体中的应用价值.方法 抽取外周血样本90份,其中21-三体患者22例,经常规染色体核型分析排除21-三体的患者68例,包括智低儿,正常体检者,染色体平衡易位携带者,有流产史的夫妇,其中45,X;45,X/46,X,del(X);46,XX,t(4;13)各1例,47,XXY 3例.应用QF-PCR方法进行多重扩增,毛细管电泳法检测并分析结果.所有样本同时进行染色体核型分析.结果 染色体核型分析中阳性组中有22例21-三体(其中有3例是易位型,46,XX(Y),t(21;21)各1例,46,XX,dup(21)1例,余为标准型);21例显示21-三体电泳图谱,68例阴性对照组全部显示为阴性结果.结论 成功建立了QF-PCR诊断21-三体染色体异常疾病的方法.定量荧光PCR诊断结果与染色体核型诊断结果具有同一性.     

染色体区带特异性绘图:应用微切割染色体带的PCR产物建立探针池进行染色体原位抑制杂交

染色体绘图是一种新技术,它应用微切割染色体区带的PCR产物建立探针池进行染色体原位抑制杂交(GISS),并且把染色的原位杂交和染色体的原位抑制杂交结合起来。它将对细胞遗传学的研究和进展起重大作用。微切割染色体的标本来自健康供血者(46,XX、46,XY)。病例1核型为46,XY/47,XY+mar,EBV转化淋巴细胞;病例2和病例3核型分别为46,-XY,+t(X;Y)(p21.3;p11.2)和5倍X染色体。材料分别来自外周血淋巴细胞和含人类2号染     

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.     

Complex chromosome 9, 20, and 22 rearrangements in acute lymphoblastic leukemia with duplication of BCR and ABL sequences

Cytogenetic analysis was performed on bone marrow cells from a 28-year-old woman who was diagnosed with acute lymphoblastic leukemia (ALL). Her karyotype was: 46,XX,t(9;22)(q34;q11)[6]/47, XX,+8,t(9;22)(q34;q11)[4]/47,XX,+8,t(9;22)(q34;q11),del(20)(q11)[2]/46, XX,t(9;22)(q34;q11),del[20](q11)[7]/45,XX,der(9)t(9;22)(q34;q11),-20,-22 , +mar1[8]/45,XX,der(9)t(9;22)(q34;q11),-20,-22,+mar2[3]. Both marker chromosomes are dicentric and have the same size and banding pattern but different primary constrictions. Fluorescence in situ hybridization (FISH) demonstrated that both markers were derived from chromosomes 9, 20, and 22. FISH with the bcr/abl probe showed fusion of the BCR gene with the ABL gene; however, this fusion signal was present in duplicate on both marker chromosomes. To our knowledge, duplication of the BCR/ABL fusion signal on a single chromosome arm has not been reported before, except for the extensive amplification of BCR/ABL fusion signals in the leukemic cell line K-562. These data demonstrate that the marker chromosomes are the result of complex genomic rearrangements. At the molecular level, the BCR/ABL fusion gene encodes the p190 fusion protein. Similar findings have never been observed in any case of ALL.     

Multiple apparently unrelated clonal chromosome abnormalities in a squamous cell carcinoma of the tongue

We have cytogenetically examined short-term cultures from a squamous cell carcinoma of the tongue, a tumor type in which chromosome aberrations hitherto have not been reported. No less than 12 pseudodiploid clones were detected, giving the tumor karyotype 46,X,der(X)t(X;1)(q26;p32),der(1)(Xqter→Xq26::1p32→cen→1q42:),del(13)(q11q21),t(15;?) (q26;?)/46,XX,t(1;?)(p34;?),inv(2)(p21q11)/46,XX,t(1;10)(p32;q24)/46,XX,+der(1)(12pter→ 12p11::1p11→cen→1q32::11q13→11q32→1q42:),del(11)(q13q22), - 12, der(17)t(1:17) (q42;p13)/46,XX,inv(1)(p22q44)/47,XX,del(1)(q32),der(17)t(1:17)(p22;q25),der(1)inv(1) (q25q44)t(1;17)(p22;q25),ins(14;7)(q11;q22q36), + 14/46,XX,t(1;4)(q23;q35)/46,XX,t(1;21) (q25;q22),t(2;10)(q31;q26),t(22;?)(q12;?)/46,XX,del(1)(q32)/46,XX,t(1;8)(q44;q21)/46,XX, t(2;21)(q11;p11)/46,XX,t(9;11)(q34;q13). The large number of apparently unrelated abnormalities leads us to suggest that the carcinoma may have been of multiclonal origin.     

Pigmentary dysplasias and chromosomal mosaicism: Report of 9 cases

Chromosomes were studied in 9 individuals with pigmentary dysplasias of the skin and other abnormalities. Of the 9 individuals, 5 were chromosomal mosaics in both blood lymphocytes and skin fibroblasts (46,XY/47,XY,+13;46,XX/47,XX,+14;46,XY/47,XY,+18;46,XX/47,XX,+18;46,XX/47. XX,+mar), while the other 4 individuals were chromosomally normal in both tissues studied. The pigmentary dysplasias involved hypo- or hyperpigmented patches/flecks or lines/whorls. The latter ran along Blaschko lines on the back, abdomen and the limbs. These patterns varied not only between individuals but also between different regions of an individual. The possibility of chimerism was studied but ruled out (1/32 to 1/256) in 7 individuals, using chromosomal heteromorphisms in the patients and their parents as markers. © 1992 Wiley-Liss, Inc.     

Unique karyotypes in two patients with Prader-Willi syndrome.

A physical disruption of the Prader-Willi syndrome (PWS) chromosome region is thought to cause PWS. We describe 2 girls with PWS phenotype, who had unique chromosome 15 abnormalities. The first patient showed mosaicism: 45,XX,t(15;15)(qter----p11.1::q11.200----qter)/46,XX,t(15;15)(qter----p1 1.1::q 11.200----qter), +mar. The band 15q11.2 apparently remained intact in the t(15;15) chromosome, and the mar chromosome was considered as r(15) (p11.1q11.1). The second patient had a karyotype of 47,XX,del(15)(q11.200----q11.207), +idic (15)(pter----q11.1::q11.1----pter). The complex breakage and reunion involving the 15q11.2 regions of the father's homologous chromosomes 15 at meiosis appeared to have resulted in the idic(15) and the del(15) chromosomes. These cytogenetic findings suggest that the PWS chromosome region may be localized on the very proximal portion of band 15q11.2.     

A small supernumerary marker chromosome X identified by in situ hybridization

Cytogenetic analysis of a girl with moderate mental retardation and dysmorphic features revealed a 46,XX/47,XX,+mar karyotype. Fluorescence in situ hybridization using chromosome specific alpha satellite probes showed that the supernumerary marker originated from the X chromosome. To our knowledge, this is the first reported case of a female patient mosaic for a supernumerary small marker chromosome derived from X, and hence mosaic for trisomy of the pericentric region of the X chromosome.     

Unique karyotypes in two patients with Prader-Willi syndrome

A physical disruption of the Prader-Willi syndrome (PWS) chromosome region is thought to cause PWS. We describe 2 girls with PWS phenotype, who had unique chromosome 15 abnormalities. The first patient showed mosaicism: 45,XX,t(15;15)(qter→p11.1::q11.200→ qter)/46,XX,t(15;15)(qter → p11.1::q11.200→ qter), + mar. The band 15q11.2 apparently remained intact in the t(15;15) chromosome, and the mar chromosome was considered as r(15) (p11.1q11.1). The second patient had a karyo-type of 47,XX,del(15)(q11.200→q11.207), + idic (15)(pter → q11.1::q11.1→pter). The complex breakage and reunion involving the 15q11.2 regions of the father's homologous chromosomes 15 at meiosis appeared to have resulted in the idic(15) and the del(15) chromosomes. These cytogenetic findings suggest that the PWS chromosome region may be localized on the very proximal portion of band 15q11.2.