东营地区90例原发闭经者临床特征及细胞遗传学分析

对90例原发闭经患者进行了外周血淋巴细胞染色体检查,发现性染色体异常核型34型,占总数的37.7%,其中45,X 17例,嵌合体和/或染色体结构异常者17例,各占50%.46,XY,15例,占总数的16.67%;46,XX,41例,占总数的45.56%.性染色体数目和/或结构异常,可导致身材矮小、性腺发育不全、两性畸形、原发闭经、不孕等临床表现.因而对原发闭经患者进行细胞遗传学检查,应列为首选检查项目.     

许昌地区149例原发闭经患者的细胞遗传学分析

目的 对原发闭经患者进行细胞遗传学检查，探讨性染色体与原发闭经的关系。方法 采用外周血淋巴细胞染色体培养技术进行染色体核型分析。结果 149例患者中共检出异常核型56例，异常率为37，6％（56／149）。其中45，X26例，占总病例17．4％，占异常核型46．43％；46，XY17例，占总病例11．4％，占异常核型30．36％；嵌合体8例，占总病例5．4％，占异常核型14．29％；结构异常5例，占总病例3．4％，占异常核型8．92％。结论 性染色体异常是引起原发闭经的一个重要因素，对原发闭经患者进行外周血染色体检查具有重要的临床意义。     

梧州地区原发闭经52例临床分析

目的通过观察原发闭经患者临床特点、诊治目的，探讨其诊断与治疗方法。方法对52例原发闭经患者的临床表现、染色体核型、性激素测定及治疗结果进行回顾性分析。结果52例原发闭经患者中，先天性无阴道28例，占53．85％；性发育异常22例，占42．31％；低促性腺性闭经2例，占3．85％。其中染色体核型为46，XX32例，45，XO及嵌合体18例；45，X0／46，XY及46，XY各1例。性激素测定正常28例，异常24例。手术治疗17例；性激素替代治疗18例，皮质激素治疗2例。结论对原发闭经患者应尽早行性激素测定及染色体检查，了解遗传学基础。生殖器发育异常者予手术纠正，性激素异常者，予激素替代治疗。     

新疆地区84例原发性闭经患者的细胞遗传学分析

目的 探讨原发性闭经与染色体异常的关系.方法 对84例原发性继发闭经患者进行染色体核型分析.结果 共发现38例核型异常,异常率为45.24％.异常核型主要为性染色体数目或结构异常,共检出34例,其中45,X、46,XY、45,X嵌合体较为多见;嵌合体中以45,X/46,XX和45,X/46,XY检出率较高;X染色体结构异常多表现为等臂、缺失、环状及倒位.结论 染色体异常是原发性闭经的重要原因之一.对患者应进行核型检查,为早期诊断和治疗提供依据.     

性腺发育不全患者荧光原位杂交和BAC-FISH的诊断

目的 探讨荧光原位杂交(fluorescence in situ hybridization,FISH)和BAC-FISH(bacterial artificial Chromosonle-FISH)在性腺发育不全患者临床医学遗传学诊断中的应用.方法 对5例临床检查诊断为性腺发育不全患者进行染色体荧光Q显带、G显带核型分析、FISH和BAC-FISH等分子-细胞遗传学检查诊断.结果 5例性腺发育不全患者中2例为46,XY核型的单纯性性腺发育不全,另外3例分别为45,X/47,XXX;45,X/46,XY或45,X/46,X,der(Y)嵌合体核型的混合性性腺发育不全.结论 性染色体的异常是导致患者性腺发育不全的原因,结合应用FISH和BAC-FISH等分子-细胞检测技术可为性腺发育不全患者的临床诊断和治疗提供准确的医学遗传学依据.     

59例闭经女性的外周血染色体核型分析及临床意义

目的探讨原发和继发性闭经患者外周血染色体核型的分布及临床意义。方法常规外周血淋巴细胞培养制备染色体,G显带核型分析。结果在59例闭经患者中共检出染色体异常28例,总异常率为47.46%,其中53例原发闭经患者染色体异常28例,异常率占52.83%[45,X16例、45,X/46,X,i（Xq）3例、46,X,i（Xq）1例、46,XY5例、47,XXX1例、46,XY/45,X 1例、46,X,dup（Xp）1例];6例继发闭经患者染色体结果均正常。结论染色体异常是原发闭经发生的重要原因之一,对该类患者进行外周血染色体核型分析,特别是14岁以上第二性征不发育、身材矮小、肘外翻的女性应该做到早期诊断和治疗。     

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。     

羊水细胞荧光原位杂交技术及染色体核型分析在特纳综合征中的应用

目的探讨羊水细胞荧光原位杂交(fluorescence in situ hybridization,FISH)技术与染色体核型分析联合检测特纳(Turner)综合征,并结合产前超声筛查结果,评价FISH技术在产前诊断中的应用价值。方法对2010年1月至2012年12月来院产前遗传学诊断6455例孕妇,抽取羊水体外细胞培养后用常规G显带技术染色体核型分析为Turner综合征5例,正常对照2例,同时用FISH检测间期细胞13、18、21及X\Y的染色体数目。结果 Turner综合征5例中2例为染色体核型及FISH检测45,X,超声筛查结果异常;3例为染色体核型46,X,i(X)(q10),FISH检测正常,超声筛查结果异常;2例为染色体核型46,XX,FISH检测正常,超声筛查结果未见明显异常。结论 (1)FISH技术应用于产前诊断较常规核型分析方法有效缩短报告时间,但在Turner综合征染色体结构异常的患者,单纯使用FISH将发生漏诊。(2)FISH检测不能完全替代常规染色体核型分析,必须同时行羊水细胞染色体核型分析。     

深圳地区78例原发性闭经患者的细胞遗传学分析

目的探讨原发性闭经患者在细胞遗传学水平上的主要特征和发病机制。方法采用外周血淋巴细胞染色体培养技术进行染色体核型分析。结果 78例原发性闭经患者共检出染色体异常31例,异常检出率为39.74%,主要为46,XY、45,X0嵌合和X染色体数目异常,包括11例46,XY,9例45,X0嵌合,6例45,X0,4例X染色体结构异常。结论染色体异常是导致原发性闭经的重要原因之一,对原发性闭经患者进行细胞遗传学检查对确定病因和治疗方案是非常必要的。     

372例原发性闭经患者的细胞遗传学分析

目的收集分析原发性闭经患者的细胞遗传学及临床特征,探究原发性闭经与染色体异常的关系。方法对2012年1月至2016年12月在广西壮族自治区妇幼保健院就诊的72例原发性闭经患者,行染色体核型分析。结果 72例原发性闭经患者,46例染色体核型正常,26例核型异常,异常率为36.2%。异常核型包括性染色体数目或结构异常,以及染色体多态性,其中10例45,X,4例46,XY,以及45,X的嵌合体3例,X染色体缺失2例、染色体易位1例,以及6例染色体多态性。结论染色体异常是原发性闭经的重要原因之一,对原发性闭经患者应进行核型检查,为早期诊断和治疗提供依据。     

Cytogenetic analyses of premature ovarian failure using karyotyping and interphase fluorescence in situ hybridization (FISH) in a group of 1000 patients

Lakhal B, Braham R, Berguigua R, Bouali N, Zaouali M, Chaieb M, Veitia RA, Saad A, Elghezal H. Cytogenetic analyses of premature ovarian failure using karyotyping and interphase fluorescence in situ hybridization (FISH) in a group of 1000 patients. To evaluate the implication of chromosome abnormalities in the etiology of premature ovarian failure (POF), 1000 patients with POF recruited at the Department of Cytogenetics of Farhat Hached Hospital (Sousse, Tunisia) between January 1996 and December 2008. Chromosome analyses were performed by using karyotyping and interphase fluorescent in situ hybridisation (FISH) using a centromeric probe of the chromosome X to look for low‐level mosaicism of X‐chromosome monosomy. Hundred and eight chromosomal abnormalities (10.8%) were found using karyotype analysis. Anomalies were detected in 61 cases out of 432 primary amenorrhea patients (14.12%) and 47 cases out of 568 secondary amenorrhea patients (8.27%). In 23 POF patients among 200 (11.5%) with 46,XX normal karyotype and explored using interphase FISH analysis, the percentage of cells with X‐chromosome monosomy was significantly higher as compared with controls in the same age. The cytogenetic study of POF patients showed a high prevalence of chromosome anomalies either in primary or in secondary amenorrhoea. Mosaic X‐chromosome s aneuploïdy was the most frequent abnormality and some patients with POF may be attributable to low‐level 45,X/46,XX mosaicism detectable using FISH analysis.     

广州地区176例闭经患者的细胞遗传学分析

目的探讨细胞遗传水平上原发性闭经和继发性闭经患者的发病机理。方法 156例原发性闭经患者,20例继发性闭经患者的外周血进行培养、制片、烘烤、胰酶消化和染色。每例标本观察20个核型,分析3～5个核型。如果遇到嵌合体,观察100例。结果在176例患者中,检测出48例染色体核型异常患者,异常核型率为27.27%,主要为X染色体数目异常和45,XO嵌合体,包括14例45,XO,19例45,XO嵌合体,5例X染色体结构异常,6例46,XY。156例原发性闭经患者中检测出46例异常核型,而在20例继发性闭经患者中检测出2例异常核型。结论染色体异常是引起原发性闭经和继发性闭经的重要原因,对闭经病人进行染色体检测对确定其病因和治疗是必要的。     

True hermaphroditism with ambiguous genitalia due to a complicated mosaic karyotype: clinical features,cytogenetic findings,and literature review

Abnormal recombination between the X and Y chromosomes during meiosis, occurring outside the pseudoautosomal region, can result in translocation of the SRY gene from the Y to the X chromosome, and consequently in abnormal sexual differentiation, such as the development of 46,XX males or true hermaphroditism. In this report we present clinical, cytogenetic, and molecular-cytogenetic data of a patient with ambiguous genitalia and true hermaphroditism, who had a unique mosaic karyotype, comprising three different cell lines: 46,XX(SRY+), 45,X(SRY+), and 45,X. The mosaic karyotype of our patient probably represents two different events: abnormal recombination between the X and Y chromosomes during paternal meiosis, and postzygotic loss of one of the X chromosomes. Replication studies demonstrated that in 80% of the XX cells, the SRY sequence was located on the active X chromosome. This finding suggests nonrandom X inactivation and, together with the presence of the SRY gene, explains the male phenotype of our patient. On the other hand, the presence of the 45,X cell line may have contributed to genital ambiguity. We conclude that fluorescence in situ hybridization (FISH) analysis with SRY probes is highly recommended and allows accurate diagnosis and optimal management in cases of 46,XX hermaphroditism and ambiguous genitalia.     

9号环状染色体综合征的荧光原位杂交分析

目的 对1例9号环状染色体综合征患儿进行细胞分子遗传学分析,探索9号环状染色体与临床表型的关系.方法 采用染色体G显带核型分析和TelVision 9p探针和TelVision 9q探针进行双色荧光原位杂交,识别和定位1例9号环状染色体患儿.结果 患儿核型为45,X,-9/46,XX,r(9)(p24q34)/46,XX,r(9;9)(p24q34;p24q34)(4/92/4).双色荧光原位杂交显示9号环状染色体上没有杂交信号,提示9号环状染色体短臂末端缺失片段至少有115 kb,长臂末端缺失片段至少有95 kb.与其它报道的环状9号染色体综合征、9号染色体短臂和长臂部分单体综合征相比,本例患者兼有环状9号染色体综合征的临床特征以及9号染色体短臂和长臂部分单体综合征的一些特征.结论 由于缺失的断裂点之间亚显微结构的不同、环的不稳定性、基因与表型相互作用以及胎儿环境条件的不同等原因,具有相同断裂点的9号环状染色体综合征患者可以有不同的临床表型,单倍基因剂量不足对临床表型发挥了重大作用.     

Detection of low level sex chromosome mosaicism in Ullrich-Turner syndrome patients

Ullrich-Turner syndrome (UTS) is most commonly due to a 45,X chromosome defect, but is also seen in patients with a variety of X-chromosome abnormalities or 45,X/46,XY mosaicism. The phenotype of UTS patients is highly variable, and depends largely on the karyotype. Patients are at an increased risk of gonadoblastoma when a Y-derived chromosome or chromosome fragment is present. Since constitutional mosaicism is present in approximately 50% of UTS patients, the identification of minor cell populations is clinically important and a challenge to laboratories. We identified 50 females with a 45,X karyotype as the sole abnormality or as part of a more complex karyotype. Twenty two (44%) had a 45,X karyotype; mosaicism for a second normal or structurally abnormal X was observed in 24 (48%) samples, and mosaicism for Y chromosomal material in 4 (8%) cases. To further investigate the possibility of mosaicism in the 22 patients with an apparently non-mosaic 45,X karyotype, we performed FISH using centromere probes for the X and Y chromosomes. A minor XX cell line was identified in 3 patients, and the 45,X result was confirmed in 19 samples. No samples with XY mosaicism were identified. We describe our validation process for a FISH assay to be used in clinical practice to identify XX or XY mosaicism. FISH as an adjunct to karyotype analysis provides a sensitive and cost-effective technique to identify sex chromosome mosaicism in UTS patients.     

Mosaic Turner syndrome: cytogenetics versus FISH

Twenty-two cases with Turner syndrome features were subjected to standard cytogenetic techniques using giemsa trypsin (GTG-) banding then fluorescence in situ hybridization (FISH) using a specific whole-X chromosome painting probe, Quint-Essential Y-specific DNA probe (AMELY) for Yp11.2, alpha-satellite (DYZ3) probe and X/Y cocktail-alpha satellite probe (ONCOR) for confirmation of the initial diagnosis and comparison of the two techniques. Eight cases (36%) showed the same karyotype results by both techniques [5 cases: 45,X/46,XX, 2 cases: 45,X/46,X,i(Xq) and one case with a triple cell line 45,X/46,XX/47,XXX]. In the other 14 cases (64%) the FISH technique has identified a third cell line in 7 cases (32%), delineated the origin of the marker in 5 cases (23%) to be derivative X and clarified the deletion of the Yp11.2 region in 2 cases (9%) with the 45,X/46,XY karyotype. The application of FISH has highlighted the differences between the initial diagnosis based on the standard cytogenetic technique and the final diagnosis determined by the application of DNA probes specific for the X and Y chromosomes. FISH proved useful in detection of the low frequency cell lines which need analysis of a large number of metaphase spreads by GTG-banding, helped in identifying the nature and the origin of the unknown markers which has an important implication in the development of gonadal tumours and delineated the deletion of the Yp11.2 region in the 45,X/46,XY Turner patients.