非综合征性唇腭裂与亚甲基四氢叶酸还原酶基因A1298C相关性的研究

目的 研究亚甲基四氢叶酸还原酶基因(methylenetetrahydrofolate reductase,MTHFR)A1298C多态性与中国华北人群非综合征性唇腭裂(non-syndromic cleft lip with or without cleft palate,NSCL/P)的关系.方法 通过聚合酶链反应-限制性片段长度多态性,在158例NSCL/P患者和192名健康对照中,对MTHFR基因A1298C单核苷酸多态性(single nucleotide polymorphism,SNP)rs1801131进行检测.利用拟合优度卡方检验分析基因型分布频率是否符合Hardy-Weinberg平衡定律;应用Unphased软件分析等位基因频率与NSCL/P的相关性.结果 MTHFR基因A1298C多态性基因型频率分布符合Hardy-Weinberg平衡;等位基因和基因型频率在唇裂合并或不合并腭裂组和健康对照组之间差异无统计学意义;基因型分布单纯腭裂(AA 78%、AC+CC 22%)与健康对照组(AA 74%、AC+CC 26%)比较,差异有统计学意义(χ2＝4.256,P=0.039),AC+CC基因型频率健康对照组(26%)高于单纯腭裂组(22%)(OR=0.8,95%CI=0.381～1.683).结论 MTHFR A1298C多态性位点可能与中国人群非综合征性单纯腭裂的发生有关.

Abstract：

Objective To investigate the association between a polymorphism of methylenetetrahydrofolate reductase with Non-syndromic cleft lip with or without cleft palate(NSCL/P)in Chinese population. Methods The polymerase chain reaction (PCR)-based restriction fragment length polymorphism(RFLP)technique was used to detect a single nucleotide polymorphism(SNP), rs1801131, at the methylenetetrahydrofolate reductase(MTHFR)gene in both 158 patients with NSCL/P and 192 healthy individuals. The Hardy-Weinberg equilibrium for genotypic distributions was estimated by the goodness-of-fit test. The UNPHASED program was applied to perform the association analysis. Results The genotypic distribution of A1298C was not deviated from the Hardy-Weinberg equilibrium in both controls and patients. No association was found between cleft lip with or without palate(CL/P)and controls. There was significant difference of cleft palate only(CPO)and the healthy individuals(χ2＝4.256, P=0.039). The frequency of AC+CC genotype was higher in control group than that in CPO group(OR=0.8, 95%CI=0.381-1.683),26 among 100 healthy individuals carried AC+CC genetypes,which were carried by 22% of CPO patients. Conclusions The polymorphism of MTHFR A1298C may be involved in the occurrence of non-syndromic cleft palate only in Chinese population.     

非综合征型唇腭裂易感基因的研究进展

<正>唇腭裂(cleft lip and palate,CLP)是常见的先天性发育畸形,全世界发病率为1/500～1/1 000。我国为唇腭裂高发国家,发病率高达1.82‰,总发生率占我国出生缺陷的14.01%。先天性唇腭裂常分为综合征型唇腭裂(syndromic cleft lip and/or cleft lip,SCL/P)和非综合征型唇腭裂(nonsyndromic cleft lip and/     

用颈椎骨龄对单侧完全性唇腭裂患者发育情况的评估

目的：用颈椎骨龄来评估单侧完全性唇腭裂（unilateral complete cleft lip and palate ,UCLP）患者的发育情况。方法将45例9～16岁的UCLP患者作为试验组（UCLP组）;另选取年龄、种族与UCLP组相匹配的45例非唇腭裂（none cleft lip and palate,Non?cleft）患者作为对照组（Non?cleft组）。拍摄头颅定位侧位片。通过头颅定位侧位片分别测量计算UCLP组与Non?cleft组的颈椎骨龄。对相同性别的UCLP组与Non?cleft组分别进行独立样本t检验。结果 UCLP组男性患者的颈椎骨龄比Non?cleft组小且差异有统计学意义（P<0.05）,而UCLP组女性患者的颈椎骨龄与Non?cleft组差异无统计学意义（P>0.05）。结论与Non?cleft患者相比,9～16岁年龄段男性UCLP患者的发育相对迟缓,而女性患者之间无明显差异。     

MSX1基因A274V多态性与非综合征性唇腭裂的关系

目的 研究同源异型盒基因1 (muscle segment homeobox1,MSX1) A274V多态性与非综合征性唇腭裂(non-syndromic cleft lip with or without cleft palate,NSCL/P)的关系.方法 利用聚合酶链反应-限制性片段长度多态性方法,在162例非...     

侧腭突生长发育和腭裂的分子调节机制

唇腭裂是一类常见的先天性畸形．可单独发生,也可与300多种已知的畸形伴发于综合征。唇腭裂又分为4型：综合征性唇裂伴或不伴腭裂（cleft of lip with or without palate,CL／P）、综合征性腭裂（cleft palat,CPO）、非综合征性唇裂伴或不伴腭裂（nonsyndromic cleft of lip with or without palate．nsCL／P）和非综合征性腭裂（nonsyndromic cleft palate．nsCPO）．     

正畸结合上颌前部牵引成骨矫治严重骨性畸形唇腭裂患者

Objective To treat cleft patient with maxillary deficiency by means of orthodontics and maxillary distraction osteogenesis. Method Maxillary distraction osteogenesis was performed to increase bone mass and orthodontic treatment was carried out after surgery. Results The cleft patient with maxillary deficiency was treated successfully, ANB was increased by 9° and good occlusal relationship was achieved. Conclusions The cleft patient with maxillary deficiency could be treated successfully with maxillary distraction osteogenesis and orthodontics.     

BMP4、TGF-β3基因多态性与环境暴露在非综合征性唇腭裂发生中的交互作用

目的 探讨环境暴露因素、骨形态生成蛋白4(BMP4)基因、转化生长因子β3(transforming growth factor beta-3,TGF-β3)基因之间的交互作用在非综合征性唇腭裂(nonsyndromic cleft lip and cleft palate,NSCLP)发生中的可能作用.方法 通过问卷调查获取环境暴露资料.用聚合酶链反应(PCR)-限制性片段长度多态性(restriction fragment length polymorphism,RFLP)技术对对照组(200例)和NSCLP组(200例)各基因位点的多态性进行检测.采用多因子降维法(multifactor djmensionality reduction,MDR)分析基因之间、基因与环境之间的交互作用关系,并对筛选的交互作用关系用Logistic回归进行验证.结果 BMP4 T538C、TGF-β3 C641A和TGF-β3G15572-三个单核苷酸多态性(single nucleotide polymorphism,SNP)位点间的交互作用与NSCLP的发生无关联.基因与环境交互作用分析发现,BMP4 T538C与母亲妊娠早期被动吸烟、母亲妊娠早期感染史对NSCLP的发生具有交互作用;TGF-β3G15572-与母亲妊娠早期被动吸烟、母亲妊娠早期感染史、父亲知晓妊娠前吸烟、父亲知晓妊娠前饮酒、母亲妊娠早期补充维生素对NSCLP的发生具有交互作用.经Logistic回归验证,结果一致.结论 NSCLP是基因与环境因素共同作用的结果,易感基因多态性影响着个体对环境因素的反应,研究它们之间的相互关系对阐明NSCLP的病因及发病机制具有重要意义.     

Sommerlad腭帆提肌重建术后瘘发生率的研究

目的:研究Sommerlad腭帆提肌重建术后瘘的发生率以及影响因素.方法:对176 例腭裂修复术后瘘的发生率和可能影响瘘发生的因素如性别、年龄、腭裂类型、裂隙的程度、手术方法以及术者技能进行回顾性研究.结果:总瘘孔率为6.8%(12/176).发生于硬软腭交界处的瘘孔率为66.7%,硬腭前部的瘘孔率为25%,软腭区域的瘘孔率为8.3%(P＜0.05).瘘的发生率与年龄、性别及裂隙的程度无关(P＞0.05).专家组手术后瘘的发生率为2.4%,低于住院医师手术后瘘的发生率10.6%(P＜0.05).硬软腭裂组(hard and soft cleft palate, HSCP)与双侧完全性腭裂组( bilateral complete cleft palate, BCCLP)瘘的发生率分别为20.6%, 9.6%, 大于单纯性软腭裂组(soft cleft palate, SCP)和单侧完全性腭裂组(unilateral complete cleft palate, UCCLP) (均为2.7%)(P＜0.05),前后2 组内部之间瘘的发生率均无统计学差异(P＞0.05).结论:Sommerlad腭帆提肌重建术并没有增加腭瘘的发生率,瘘的发生率与腭裂类型,术者的操作技能有一定关系.     

非综合征型唇腭裂与MTHFR基因多态性的相关性研究

目的：研究亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase,MTHFR）基因位点C677T和A1298C与中国江苏地区汉族人群非综合征型唇腭裂（（nonsyndromic cleft lip with or without cleft palate,NSCL/P）发生的相关性。方法：采用聚合酶链反应-限制性片段长度多态性检测法对200例NSCL/P患者和213例健康人进行基因型检测。结果：MTHFR C677T对照组与病例组在基因型分布无统计学差异（P〉0.05）,TT基因型和携带T等位基因儿童罹患NSCL/P的风险分别是CC基因型儿童的1.84倍及1.57倍。进一步分层分析发现TT基因型和CT基因型能分别显著增加儿童唇裂伴或不伴腭裂和单纯性唇裂的发病风险。MTHFR A1298C病例组和对照组在基因型频率和等位基因频率有统计学差异（P〈0.05）,AC基因型和携带C等位基因的儿童罹患NSCL/P的风险分别比AA基因型儿童降低49%及43%。分层分析中,AC基因型和携带C等位基因可降低罹患唇裂伴腭裂及唇裂伴或不伴腭裂的风险。结论：MTHFR C677T可能为中国江苏地区汉族儿童NSCL/P的危险因素,而MTHFR A1298C有可能是NSCL/P发生的保护因素。     

中国人群非综合征性唇腭裂患者IRF6基因突变检测

目的 探讨干扰素调节因子6(interferon regulatory factor 6, IRF6) 在非综合征性唇腭裂(non-sydromic cleft lip and/or cleft palate,NSCL/P)患者中的突变情况。方法：收集119例NSCL/P患者及288名健康人对照样本的外周血血样并提取DNA。在IRF6基因的全部外显子分别设计引物,PCR扩增其序列,通过测序找出IRF6基因突变,并将这些突变在对照样本中进行验证。结果：共发现5种在正常人中没有的突变,其中4种是新发现的突变。结论：IRF6基因突变在中国人群中参与了非综合征唇腭裂疾病的发生。     

亚甲基四氢叶酸还原酶C677T多态性与非综合征性唇腭裂的关系

目的研究亚甲基四氢叶酸还原酶基因C677T多态性与非综合征性唇腭裂的关系。方法利用聚合酶链反应-限制性片段长度多态性方法（PCR-RFLP）,在168例非综合征性唇腭裂患者和192名正常对照中,对MTHFR基因C677T单核苷酸多态性（SNP,rs1801133）进行检测。利用拟合优度卡方检验,分析基因型分布频率是否符合Hardy-Weinberg平衡定律;应用UNPHASED软件包分析多态性位点与非综合征性唇腭裂的相关性。结果MTHFRC677T多态性基因型频率分布符合Hardy-Weinberg平衡;MTHFR C677T等位基因分布在NSCL／P组与对照组之间有显著性差异（P〈0.05）,正常组中T等位基因的频率明显高于NSCL／P组。结论MTHFR C677T多态性位点在中国人群中与非综合征性唇腭裂形成的发生相关联。     

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目的探讨亚甲基四氢叶酸还原酶（MTHFR）基因A1298C多态性与山西人群非综合征性唇腭裂（nonsyndromic cleft lip with or without cleft palate,NSCL／P）的相关性。方法选取2010年9月至2012年4月山西地区150例NSCL／P患者及其父母作为病例组（其中有135个完整的NSCL／P核心家系）,150例正常新生儿作为对照组,应用聚合酶链式反应一限制性片段长度多态性（PCR—RFLP）分析方法,对MTHFR基因A1298C位点的多态性进行检测,利用人群关联研究分析、病例组核心家系的传递不平衡检验（TDT）、单体型的相对危险度（HHRR）分析来研究该突变与NSCL／P的相关性。结果病例组和对照组人群基因型均未偏离Hardy-Weinberg遗传平衡定律（P〉0．05）;病例组与对照组进行子代间比较,AA、AC、CC3种基因型分布差异有统计学意义（P〈0．05）,A等位基因和c突变等位基因的分布差异均有统计学意义（P〈0．05）;NSCL／P核心家系TDT检验,差异有统计学意义（P〈0．05）,表明突变等位基因c存在着传递失衡的现象;HHRR检验结果表明,MTHFR基因A1298C位点多态性由双亲传递给患病子女的等位基因（C／A）频率差异有统计学意义（P〈0．05）。结论MTHFR基因A1298C位点多态性与山西人群NSCL／P的发生存在关联。     

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目的    研究亚甲基四氢叶酸还原酶（MTHFR）基因 C677T多态性与山东地区非综合征性唇腭裂（NSCL／P）的相关性。方法    于2008 年 9月在山东省优生技术重点实验室采用聚合酶链反应-限制性片段长度多态性（ PCR-RFLP）分析,对2006 年8月至2008年8月曾在齐鲁医院治疗的来自山东地区NSCL／P患儿家庭34户和健康查体的正常儿童家庭46户的家庭成员MTHFR基因的C677T基因型进行检测。结果    携带T等位基因的父母,其子代患NSCL／P的危险性是不携带T等位基因父母的子代的2.420倍;母子都是TT突变纯合子,子代患NSCL／P的危险性是母子为非TT纯合子的4.162倍;子代是TT突变纯合子患NSCL／P的危险性是非TT纯合子的3.812倍。结论    山东地区NSCL／P与MTHFR基因 C677T的多态性相关,与父母的基因型存在联系;T基因在母子组合的研究中有统计学意义,父母传递给子代的T等位基因对后代的患病有重要作用。     

Obturators for cleft lip and cleft palate

Cleft Lip and palate are most common congenital anomalies of the faces. Infants born with cleft lip and palate always have feeding problem. They were referred to dentists for obturators. Obturators usually have definite retention, lead to easily dislodgement. The author suggested the method of fabricating more retentive obturator.     

Reoperations in cleft lip and cleft palate treatment

The surgical management of cleft lip and palate is a difficult and complex endeavor. Several surgical techniques for the treatment of this deformity have been described around the world; each one, when properly done by expert surgeons, renders good and predictable results most of the times. However, the fact that there are so many techniques means that there is no universal procedure that will always deliver great esthetic and functional results. This article discusses the causes of inadequate results in primary cleft lip and palate surgery and describes the various secondary surgical techniques to correct the same.     

Feeding infants with cleft lip, cleft palate, or cleft lip and palate

In assessing 143 infants with cleft lip and palate, we found feeding problems to vary with the patients' anatomic lesion. Effective feeding techniques were identified by first assessing the infant's ability to generate negative intraoral pressure and to move the tongue against the nipple and then by matching these deficits to appropriate feeding devices.     

Syndromes with cleft lip and cleft palate.

A series of tables is presented as a diagnostic aid for the clinician when he confronts a patient who has a cleft lip and/or palate, together with associated anomalies. The tables provide a rapid way of sorting through the recognized syndromes with orofacial clefting in search of a possible overall diagnosis. Today, 154 such syndromes are recognized. This is more than twice as many as were known in 1971. Undoubtedly, many new syndromes with orofacial clefting will be delineated in the future.