56例生长障碍患儿单核苷酸多态性基因芯片检测结果分析

目的探讨生长障碍患儿的分子遗传学基础。方法 2013年1月至12月采集56例生长障碍患儿的外周血并提取DNA,进行单核苷酸多态性基因芯片(SNP-array)检测。结果 56例患儿中12例(21.4%)有致病性拷贝数异常,性染色体异常6例,常染色体异常6例;4例(7.1%)有常规染色体核型分析无法检出的致病性微缺失或重复片段,其大小2.5 Mb。结论 SNP-array技术可作为生长障碍患儿遗传学诊断的有效方法。     

Pallister-Killian综合征1例临床及细胞分子遗传学分析

目的探讨Pallister-Killian综合征(PKS)的细胞分子遗传学特点。方法采集患儿外周血标本进行G显带染色体核型分析,单核苷酸多态性-微阵列芯片(SNP array)技术鉴定异常片段来源,运用荧光原位杂交(FISH)技术加以确认。结果女性患儿,8月龄,因精神运动发育迟缓就诊。出生后有喂养困难、肌张力低下、面容异常、后发际线低、足部畸形、双耳听力未过关等临床表现。外周血染色体G显带核型为mos 47,XX,+mar[18]/46,XX[82];芯片分析结果发现患儿12号染色体短臂嵌合重复,提示为12 p四体嵌合体;FISH检测显示有48%的细胞有4个12 p信号。结论根据临床表现,常规外周血染色体核型分析结合SNP-array及FISH检测诊断PKS。     

联合应用多种分子遗传学技术阐述染色体芯片结果中潜在的结构异常

目的探讨拷贝数变异中潜在的结构异常。方法通过联合应用常规核型分析及FISH等分子生物学技术对4例存在拷贝数变异的智能障碍合并多发畸形的患儿进行鉴定,明确其染色体结构异常;进而对2个家系进行产前诊断及随访。结果 4例患儿经染色体芯片检测发现存在拷贝数变异,分别为16pter缺失/19qter重复、18pter缺失/18qter重复、13 qter缺失和3 p 13-14缺失。联合核型分析及FISH检测明确患儿潜在的结构异常,分别为1例染色体末端不平衡易位der(16)t(16p;19q)、1例倒位重复缺失invdup18p/del 18q、1例涉及随体易位(13qs)及1例父源性平衡插入重组导致3p间隙性缺失或重复。其中2例为家族性平衡重组导致,1例未确定但存在再发风险,1例为新发改变。其中2个家系于孕中期进行产前诊断,并随访证实与产前诊断结果一致。结论染色体芯片发现单纯拷贝数变异者可能存在潜在的染色体结构异常,联合应用多种技术可以明确潜在的结构异常,并提供准确的再发风险评估,从而指导疾病的产前诊断。     

儿童肥厚型心肌病中Noonan综合征基因型与临床表型

目的 总结儿童肥厚型心肌病（HCM）中Noonan综合征的基因变异与临床特征。方法 对123例儿童肥厚型心肌病先证者进行96个遗传性心肌病相关基因的二代测序及生物信息学分析，确定变异位点；筛选出11例Noonan综合征患儿，收集其临床资料及超声心动图结果。结果 11例患儿均因心肌肥厚就诊，男5例、女6例，肥厚型心肌病诊断中位年龄2岁7个月（5个月～10岁），Noonan综合征诊断中位年龄6岁9个月（7个月～16岁）。11例患儿中10例为3号染色体RAF 1基因型，1例为12号染色体PTPN 11基因型；7例为新发变异，其中1例RAF 1基因患儿检测出同时携带与肥厚型心肌病相关的变异基因MYBPC3。11例患儿中9例具有典型Noonan综合征面部特征。11例患儿均为肥厚型心肌病，9例为梗阻性肥厚型心肌病，合并右室流出道梗阻2例，合并先天性心脏病7例。结论 以肥厚型心肌病为表型的儿童Noonan综合征多为RFA1基因型，易发生左心室流出道梗阻且多合并先天性心脏病。     

Rubinstein-Taybi 综合征临床特点及基因诊断

目的探讨Rubinstein-Taybi综合征(RSTS)的临床表型及遗传学特点。方法回顾分析2例RSTS患儿的临床资料。结果 2例男性患儿,分别为3岁和4个月,均以发育落后入院。患儿身材矮小,语言、运动发育落后,均存在毛发浓密,发际线较低;例1患儿双拇指/趾稍大,例2有高腭弓、宽鼻梁、眼睑下垂的特殊面容,双拇指/趾明显扁宽;2例患儿均有隐睾。心脏彩超均提示心脏发育异常。采用高通量测序技术及基因组芯片技术进行基因诊断,发现例1CREBBP基因存在c.152TG(L51X)杂合突变,该突变未见报道;例2染色体16p13.3区域存在2.5 Mb的缺失。结论 RSTS的主要临床表现为毛发浓密、大拇指/趾畸形、心脏发育畸形、生长发育落后等,分子检测有助于临床确诊。     

Rubinstein-Taybi综合征患儿21例临床及基因变异谱系特点

目的总结Rubinstein-Taybi综合征(RSTS)的基因变异类型和临床表型特点, 探讨其基因型与表型的相关性。方法病例系列研究, 收集2013年1月至2022年7月就诊于首都儿科研究所附属儿童医院, 通过全外显子测序或染色体芯片、拷贝数变异测序, 检出CREBBP或EP300基因变异的21例RSTS患儿的病例资料。总结其基因变异类型并回访其表型数目。根据变异类型将患儿分别分为点变异或拷贝数缺失组、EP300基因或CREBBP基因变异组、功能丧失或错义变异组。组间表型数目比较采用两独立样本秩和检验。结果 21例患儿中男12例、女9例, 年龄范围为1月龄至14岁2月龄, 14例(67%)点变异, 7例(33%)拷贝数缺失;其中20例(95%)为新生变异。20例患儿随访获得详细表型数目, 95%(19/20)在2岁以内出现神经发育迟缓, 80%(16/20)具有特殊面容。组间表型数目比较, 点变异组(14例)与拷贝数缺失变异组(6例)[5.0(3.0, 7.0)比5.0(2.5, 5.3)个, Z=0.75, P=0.452];CREBBP基因组(10例)与EP300基因变异组(4例...     

Gitelman综合征合并肾病综合征1例报告并文献复习

目的总结SLC12A3基因变异致Gitelman综合征的诊断和治疗。方法回顾分析1例Gitelman综合征合并原发性肾病综合征患儿的临床资料,系统复习Gitelman综合征合并蛋白尿文献。结果6岁男性患儿,因肾病综合征复发就诊,持续低钾血症,同时伴尿钠及尿钾排出增多,低镁血症,代谢性碱中毒,低尿钙症,肾素血管紧张素系统激活,血压无异常,无特殊用药史及家族史。全外显子测序发现患儿16号染色体1号外显子SLC12A3基因存在c.179C>T(p.T60M)纯合错义变异(NM_000339),其父母均为携带者;ACMG评分为致病性突变。患儿确诊为肾病综合征合并Gitelman综合征。结论重视Gitelman综合征蛋白尿的评估和随访,保护肾功能。     

4例Williams-Beuren综合征家系遗传学诊断与产前诊断

Williams-Beuren综合征是一类常见的染色体微缺失综合征,早期诊断及干预对患儿及其家庭十分重要。本研究应用染色体核型分析技术(G显带),多重连接依赖探针扩增技术(MLPA)及微阵列比较基因组杂交技术(array-CGH)对4个家系中1例超声异常的胎儿及3例发育异常患儿行染色体核型和基因组DNA分析,为这4个家庭的再生育提供指导,为产前诊断提供依据。研究结果发现1例产前超声异常孕妇羊水及3例发育异常患儿外周血MLPA分析提示染色体7q11.23区域ELN基因探针信号降低,array-CGH检测提示染色体7q11.23区域杂合缺失。4个家系中母亲再次妊娠时取羊水细胞标本行上述检测均未发现异常。研究结果提示MLPA技术及array-CGH技术能够快速、准确地诊断Williams-Beuren综合征,为临床提供更好的遗传咨询服务。     

染色体微阵列分析技术应用于筛查胎儿先天性心脏病的研究进展

先天性心脏病（congenital heart disease,CHD）是一种常见的出生缺陷,是由环境和遗传因素共同引起,其中遗传因素发挥着主要作用。G显带核型检测、荧光原位杂交,及染色体微阵列分析（CMA）技术是目前常见的基因诊断技术,近年来,CMA技术已逐渐成为产前诊断胎儿CHD的一线方法。CMA的主要优点之一是它能够精确定义不平衡区域,可明确诊断微缺失或微重复综合征,同时也可检测到大量的临床意义不明的拷贝数变异。在检测产前样本中总拷贝数变异时,拷贝数变异检测具有高可靠性、准确性和再现性的特点。但在许多情况下,拷贝数变异对CHD患儿心脏发育的影响尚不清楚。该文将以染色体微阵列分析技术为重点,对其在胎儿CHD的诊断意义及预后指导作一综述。     

15q11.2-13.2微重复四倍体综合征1例并文献复习

目的 采用分子遗传学技术分析1例常规染色体核型拟诊为21/22三体的发育迟缓伴孤独症患儿,明确遗传学诊断。方法 收集患儿及其父母的外周血标本,常规提取基因组DNA,应用高分辨染色体核型分析（400-550带）检测患儿及其父母的染色体数目及结构,微阵列比较基因组杂交技术(array-CGH)筛查患儿的全基因组拷贝数变异,以荧光原位杂交技术（FISH）对异常的基因拷贝进行染色体精确定位和定量。结果 女,2岁,发育迟缓伴孤独症样表现。外侧眼角下垂、内眦赘皮。常规染色体核型检查（320带）分别为47,XX,+22和47,XX,+21。高分辨染色体核型分析显示,该患儿携带额外标记染色体（SMC）,核型为47,XX,+mar dn,尚不能确定是否为21/22三体携带者,患儿父亲高分辨率核型染色体分析提示为46,XY,母亲为46,XX,提示患儿携带SMC为新生突变。array-CGH检测显示15q11.2-13.2区域微重复（chr15:22684529-30730543,8.0 Mb,hg19）。FISH验证该SMC来源于15号染色体,由15q11.2-13.2区域二倍体及双着丝粒组成。患儿最终诊断为15q11.2-13.2微重复四倍体综合征。复习文献报道的15q11.2-13.2拷贝数增加病例的临床表型,微重复四倍体综合征的主要表型有智力低下/发育迟缓（100％）、肌张力低下（92.9％）、孤独症/孤独症样表现（71.4％）和癫痫（61.5％）等。结论 15q11.2-13.2微重复四倍体综合征是患儿发生精神发育迟滞伴孤独症的遗传学基础,array-CGH能够快速、准确地检测基因组的微小失衡。     

A case with some clinical findings overlapping to Rubinstein-Taybi, Rubinstein-Taybi-like syndrome or multiple pterygium syndrome: coincidental findings or a new entity?

We report a case with broad, deviated thumb and big, duplicated, deviated toes resembling Rubinstein-Taybi syndrome. But the patient did not have severe mental retardation as in Rubinstein-Taybi syndrome and had no microdeletions on chromosome 16 by FISH-based assay. This patient had mild webbing as seen in multiple pterygium syndrome, but broad-deviated thumb has not been reported in this syndrome. We discuss whether these are coincidental or overlapping findings or whether this is a possible new clinical entity.     

Rubinstein-Taybi syndrome (RTS) with postaxial polydactyly of the foot: 4-year follow-up until improvement of dysbasia

Rubinstein-Taybi syndrome (RTS), also known as 'broad thumbs syndrome' or 'broad thumb-hallux syndrome', is a malformation syndrome characterized by the triad of broad thumbs or first toes, a peculiar facial expression called 'comical face' and mental retardation. Although various malformations are combined with the triad, polydactyly is rare. We treated a male patient with RTS complicated by postaxial polydactyly of the foot. His clinical course was different from typical patients with polydactyly, especially in the aspect of walking development. Osteoplasty-combined surgery, which was ideal for anatomical reconstruction, was performed on the patient at 2 years and 11 months of age. A 4-year follow-up period was required until there was an improvement of dysbasia.     

DEFICIENT CELL IMMUNITY AND MILD INTERMITTENT HYPERAMINOACIDEMIA IN A PATIENT WITH THE RUBINSTEIN-TAYBI SYNDROME

Abstract. Rivas, F., Fragoso, R., Ramos-Zepeda, R., Vaca, G., Hernandez, A., González-Quiroga, G., Olivares, Norma and Cantu, J. M. (Divisions of Genetics and Hematology, and Experimental Pathology, Subjefatura de Investigacion Cientifica, Unidad de Investigación Biomédica, Centro Médico de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México). Deficient cell immunity and mild intermittent hyperaminoacidemia in a patient with the Rubinstein-Taybi syndrome. Acta Paediatr Scand, 69: 123, 1980.—A boy aged 2 years 8 months presenting the Rubinstein-Taybi Syndrome (RTS) and a history of recurrent gastrointestinal and respiratory infections was studied. Partial deficient cell immunity and intermittent hyperaminoacidemia and aminoaciduria were ascertained. These findings were interpreted as evidence of phenotypic and probably genetic heterogeneity of RTS     

Rubinstein-Taybi syndrome with normal FISH result and CREBBP gene analysis: a case report

We report on a six-year-old boy with typical Rubinstein-Taybi syndrome (RSTS) phenotype. Clinical findings included mental and motor retardation, patent ductus arteriosus (PDA), undescended testes, hirsutism, broad thumbs with radial angulation and broad toes, and inguinal hernia. His karyotype was normal (46, XY) and fluorescence in situ hybridization (FISH) showed no deletion of the CREBBP [cAMP response element-binding (CREB) binding protein] gene on chromosome 16p13.3. CREBBP gene sequencing also revealed normal results. We wish to present this case because this patient had typical RSTS phenotype, but normal FISH and CREBBP gene sequencing results. It could be possible that genetic heterogeneity is related with novel mutations in other genes. With the publication of such cases, their significance will be brought to the attention of researchers in this field.     

Rubinstein-taybi syndrome in a mother and son

The Rubinstein-Taybi syndrome is a condition characterized by mental retardation, typical facial changes and broad thumbs and big toes. The cause is unknown; almost all cases are sporadic. We describe a mother and son with Rubinstein-Taybi syndrome. Literature search documented at least 413 cases with 558 sibs. An affected offspring has occurred at least twice, possibly six times. In 45 yet undescribed Dutch cases no recurrence was found in 94 sibs. A submicroscopic chromosome deletion seems the most probable explanation, but other alternatives may be possible.Abbreviation OFC skull circumference     

Congenital hypothyroidism associated with Rubinstein-Taybi syndrome

Rubinstein-Taybi syndrome is a genetic syndrome characterized by broad thumbs and big toes, growth retardation, mental deficiency and dysmorphic facies. We report the association of Rubinstien-Taybi syndrome with congenital hypothyroidism.     

Rubinstein-Taybi syndrome with humoral and cellular defects: a case report

The first association of Rubinstein-Taybi syndrome with immunodeficiency and the successful prevention of infection with intravenous IgG is reported in a 4 year old boy. This case suggests that immunodeficiency maybe a prominent feature of this syndrome and may predispose these patients to recurrent infections.     

A new variable phenotype in spinocerebellar ataxia 27 (SCA 27) caused by a deletion in the FGF14 gene

We present a young boy whose mild ataxia and abnormal eye movements repeatedly deteriorated with fever, making him unable to sit or walk during fever episodes. SNP-array analysis identified a 202 kb deletion in chromosome 13q33.1 containing the fibroblast growth factor (FGF)14 gene, which is associated with spinocerebellar ataxia (SCA) 27. This 13q deletion was also present in the proband's mother and grandmother. The mother was unable to perform tandem gait walking and had abnormal eye movements but had never sought medical attention. The grandmother predominantly had a postural tremor. FGF14 regulates brain sodium channels, especially in the cerebellum. Sodium channels can be fever sensitive. This family demonstrates phenotypic variability of FGF14 deletions (SCA 27), fever sensitivity of ataxia and the added value of SNP-array analysis in making a diagnosis.     

Rubinstein-Taybi syndrome with humoral and cellular defects: a case report.

The first association of Rubinstein-Taybi syndrome with immunodeficiency and the successful prevention of infection with intravenous IgG is reported in a 4 year old boy. This case suggests that immunodeficiency maybe a prominent feature of this syndrome and may predispose these patients to recurrent infections.     

Association of assisted reproductive technology with twinning and congenital anomalies

Recently many reports have been published on the use of intracytoplasmic sperm injection (ICSI) and the increased risk of congenital major malformations or syndromes. We present three cases with Goldenhar syndrome (one of them a twin pair) and one case with Rubinstein-Taybi syndrome (RTS), also a twin pair. All four female cases are derived from ICSI. Goldenhar syndrome with ICSI pregnancy has been reported previously but as far as we know, RTS has not been described in association with assisted reproductive technology (ART). The four new cases reported herein will contribute to a better understanding whether ICSI pregnancy increases congenital malformations.