16例Citrin蛋白缺陷所致的婴儿肝内胆汁淤积症的SLC25A13基因变异分析CSCD

目的探讨16例Citrin蛋白缺陷所致的婴儿肝内胆汁淤积症(neonatal intrahepatic cholestasis caused by citrin deficiency,NICCD)SLC25A13基因的变异特点。方法应用高通量测序法对目标基因的编码外显子和侧翼区域进行捕获,对变异位点进行Sanger测序验证和致病性分析。结果在16例NICCD患儿中,共发现致病变异15种,其中6种既往未见报道,包括IVS14-9A>G、c.1640G>A、c.762 T>A、c.736delG、c.1098delT、c.851G>A。结论通过高通量测序发现6种新变异,丰富了SLC25A13基因的变异谱,为患儿家系的遗传咨询和产前诊断提供了依据。     

一个Usher综合征Ⅰ型家系的临床表型分析及基因诊断

目的筛查一个Usher综合征Ⅰ型家系的致病变异位点,分析其基因型-表型对应关系。方法详细采集先证者的临床表型及家族史,应用高通量测序技术对先证者进行全外显子组检测。应用Sanger测序对疑似致病变异以及家系其他成员的携带情况进行验证。结果先证者10岁时出现夜盲、白内障等症状,之后发生视网膜变性,并随年龄增加出现耳聋症状。高通量测序及Sanger测序提示其携带MYO7A基因c.2694+2T>G及c.6028G>A复合杂合变异。其姐携带相同的变异位点,且表型与先证者相似。先证者女儿携带MYO7A基因c.6028G>A杂合变异,表型无异常。结论明确了一个Usher综合征Ⅰ型家系的遗传学病因,并丰富了该病的表型与基因型数据库,为遗传咨询提供了依据。     

一例早发癫痫性脑病42型患儿的临床表型及基因变异分析

目的探讨一例早发癫痫性脑病42型患儿的基因型与表型特征。方法详细询问患儿的病史,结合其临床表型、影像学及遗传学特征进行临床诊断,并对其父母进行Sanger测序验证,明确致病变异的来源。结果患儿无意识头向一侧轻度歪斜,眼球向同侧斜视,脑电图异常放电。磁共振成像显示左额后皮层可疑异常信号,伴右侧上颌窦及筛窦炎症。全外显子组测序提示患儿携带CACNA1A基因c.5789G>A杂合变异,Sanger测序提示父母双方并未携带相同的变异,提示其为新发变异。结论先证者CACNA1A基因c.5789G>A杂合变异可能是导致其早发癫痫性脑病42型的原因。     

FLNC变异致扩张型心肌病患者1例的基因检测及临床特征分析

目的对1例扩张型心肌病患者行目标基因测序, 明确其致病变异, 为临床诊断和遗传咨询提供依据。方法选择2022年4月在首都医科大学附属北京安贞医院就诊的1例扩张型心肌病患者作为研究对象, 完善患者的临床资料、病史及家族史信息。利用高通量测序技术对患者进行目标基因测序, 通过Sanger测序对候选变异进行家系验证。根据美国医学遗传学与基因组学学会(ACMG)相关指南对候选变异进行致病性判定。结果高通量测序及Sanger验证均显示患者携带FLNC基因c.5044dupG杂合移码变异。根据ACMG指南判定为疑似致病变异(PVS1+PM2_Supporting+PP4)。结论 FLNC基因c.5044dupG杂合变异可能是该患者扩张型心肌病的遗传学病因。上述结果为患者及其家族成员的遗传咨询提供了依据。     

一例德朗热综合征患儿的致病基因变异分析

目的对1例疑诊德朗热综合征(Cornelia de Lange syndrome,CdLS)的患儿进行致病基因变异检测,明确其发病原因。方法应用高通量捕获测序对CdLS相关致病基因(NIPBL、SMC1A、SMC3、RAD21和HDAC8)进行测序,用Sanger测序验证测序结果以及致病基因的家系分析。结果患儿NIPBL基因存在c.6109-1G>A杂合剪接变异,Sanger测序验证结果表明患儿父母均未携带此变异,提示为新发变异,该变异未在HGMD及ExAC数据库收录。根据Human Splicing Finder预测剪接软件,预测该剪接变异将改变NIPBL基因剪接位点,为致病性变异。未发现SMC1A、SMC3、RAD21和HDAC8基因致病性变异。结论NIPBL基因c.6109-1G>A剪接变异可能是该例患儿的发病原因,新变异的检出丰富了NIPBL基因变异谱。     

先天性失氯性腹泻患儿3例的临床特征及遗传学分析

目的探讨3例先天性失氯性腹泻(CCD)患儿的临床特征及遗传学病因。方法选取2014年6月～2020年8月于首都儿科研究所附属儿童医院就诊的3例CCD患儿为研究对象。采集3例CCD患儿及其父母的外周血样, 进行基因检测, 并通过Sanger测序进行验证。结果 3例患儿均表现为出生后反复腹泻, 有不同程度的低氯血症、低钾血症及顽固性代谢性碱中毒。基因检测结果提示其分别携带SLC26A3基因c.1631T>A(p.I544N)纯合变异、c.2063-1G>T(剪接区域变异)及c.1039G>A(p.A347T)复合杂合变异、c.270₂71insAA(p.G91kfs*3)及c.2063-1G>T(剪接区域变异)复合杂合变异, Sanger测序证实上述变异均遗传自患儿父母。结论 SLC26A3基因的变异可能是这3例患儿的遗传学病因。上述发现拓展了SLC26A3基因的变异谱。     

一个家族性进行性色素沉着和色素减退症家系的临床表型及遗传学分析

目的探讨1个家族性进行性色素沉着和色素减退症(familial progressive hyperpigmentation and hypopigmentation, FPHH)家系的临床表型和基因变异特点。方法收集患儿的临床资料及家族史, 采集患儿及其父母、大姐、二姐的静脉血样以提取DNA, 通过高通量测序分析其致病基因, 并对候选变异进行Sanger测序验证。结果先证者主要表现为进行性加重的色素沉着和色素脱失, 伴身高增长缓慢。高通量测序提示其携带KITLG基因c.105T>A(p.Asn35Lys)杂合变异, 既往未见报道。Sanger测序证实该变异与表型存在共分离。结论对于皮肤色素沉着、色素脱失斑且随年龄加重的患儿, 需警惕FPHH的可能性。KITLG基因c.105T>A(p.Asn35Lys)杂合变异可能是本例FPHH家系的遗传学病因。     

一个非综合征型耳聋家系的分子病因学分析

目的分析一非综合征型耳聋家系的分子病因,为患病家系遗传咨询和产前诊断提供依据。方法采用聚合酶链反应(polymerase chain reaction,PCR)和Sanger测序法对4名耳聋患者进行GJB2和SLC26A4基因编码区及侧翼序列测序。结果先证者GJB2基因序列测定为野生型,检出SLC26A4基因c.240delC和c.2168A>G复合杂合突变。先证者父亲检出SLC26A4基因c.240delC杂合突变,先证者母亲检出SLC26A4基因c.563T>C、c.1746delG和c.2168A>G三个杂合突变,先证者妹妹检出SLC26A4基因c.240delC、c.563T>C和c.1746delG三个杂合突变。其中,SLC26A4c.240delC为未见报道的新发框移突变,其余三个突变均为文献已报道的致病突变。结论该家系先证者、先证者母亲及先证者妹妹均为SLC26A4基因复合杂合突变导致的非综合征型耳聋,先证者父亲仅检出单杂合突变。明确基因突变有助于该家系进行遗传咨询和婚育指导,避免聋儿出生。     

NLRP7基因变异导致的3个复发性葡萄胎家系的分析

目的探讨复发性葡萄胎家系的分子遗传学病因, 为再生育提供精准指导。方法采集5个独立家系中有复发性葡萄胎病史的女性患者及其家族成员的外周血样, 提取基因组DNA, 用全外显子组测序分析筛查NLRP7、KHDC3L等相关基因的变异情况, 对候选变异通过Sanger测序和实时荧光定量PCR进行验证及家系溯源。结果全外显子组测序在3个家系中检测到了NLRP7基因变异, 其中先证者P1及其姐姐均携带NLRP7基因第1 ～ 4外显子的纯合缺失, 先证者P2携带NLRP7 c.939delG(p.Q314Sfs*6)pat和c.1533delG(p.N512Tfs*4)mat复合杂合变异, 先证者P4携带NLRP7 c.2389₂390delTC(p.A798Qfs*6)pat和c.2165A>G(p.D722G)mat复合杂合变异, 上述变异根据美国医学遗传学与基因组学学会致病性标准均判断为致病或可能致病。其中NLRP7基因第1 ～ 4外显子缺失、c.939delG(p.Q314Sfs*6)、c.1533delG(p.N512Tfs*4)和c.2389₂     

一例Ⅰ型Cornelia de Lange综合征胎儿的临床表型及基因变异分析

目的对1例疑诊为Cornelia de Lange综合征的引产儿及其亲代进行基因检测,为遗传咨询和产前诊断提供依据。方法详细询问妊娠史及家族史,结合孕期影像学检查及引产儿表型做出临床诊断。收集引产儿组织及其亲代的静脉血样,提取基因组DNA,进行全外显子组测序分析,筛查与表型相关的变异位点,并通过Sanger测序进行验证。结果孕期超声提示胎儿前臂及手形态异常、小脑蚓部发育不良、下颌偏小、双肾实质回声增强,引产后可见上肢及面部畸形。全外显子组测序提示胎儿携带NIPBL基因c.2118delG(p.Lys706fs)杂合移码变异,其父母未检出相同变异。结论NIPBL基因c.2118delG杂合移码变异可能是胎儿的致病原因。上述结果可为家系遗传咨询及指导再生育提供依据。     

Pakistan Genetic Mutation Database (PGMD); A centralized Pakistani mutome data source

The development and advancement of next generation sequencing have not only sped up the process of identifying rare variants, but have also enabled scientists to explore all variants in a single individual. The Pakistani population has a high ratio of first degree consanguinity, which is why it is a rich source for various kinds of genetic disorders.Due to the heterogeneous composition of Pakistani population, the likelihood of genetic heterogeneity for each disorder is high. Therefore, the compilation and organization of such vast genetic data is necessary to facilitate access for analysis and interpretation to researchers and medical geneticists.The increased research on Pakistani ethnic families for disease gene identification has revealed many mutations, which has led us to develop a Pakistani mutome database entitled “Pakistan Genetic Mutation Database (PGMD)”. In PGMD, the medico-genetic information about diseases are mainly compiled into Syndromic and Non-syndromic disorders. It is a public database, which can be freely accessed from http://www.pakmutation.com.At present, we have registered more than 1000 mutations, reported in about 130 different kinds of genetic disorders. Practically, PGMD will assist researchers, clinicians, and geneticists in genetic counseling and screening of population-specific mutations, which will also aid in personalized healthcare.     

What have we been trying to do and have we been any good at it? A history of measuring the success of genetic counseling

Genetic counseling as a formal clinical service was defined in 1947, though the first study of its effectiveness was not published until 1966. This history can be broadly divided in to 3 periods: 1) 1947–1980, when the focus was primarily on prevention of disability, 2) 1981–1995, when the rationales for counseling began to shift and the first studies on the psychosocial effects of genetic counseling started to appear, albeit still largely focused on reproduction, and 3) 1996 - Present, when genetic counselors increased their presence in oncology, cardiology, and other non-reproductive areas of genetic counseling. Changes in outcome measures of genetic counseling have been intertwined with technological advances in genetic testing, better and more sophisticated outcome measures, the growing professional independence and clinical positions of genetic counselors, and the influence of social scientists particularly from behavioral psychology. Despite advances, assessment of the effectiveness of genetic counseling continues is complicated by a lack of widespread agreement about the most appropriate outcome measures as well as research design problems. Broadly speaking though, genetic counseling tends to improve information recall, improve psychological well-being, and is generally well-regarded by patients.     

广西汉族群体与其他群体的群体差异分析

目的 获取15个STR基因座在南宁地区汉族群体的群体遗传学和法医学数据,并分析南宁汉族群体与广西其他群体的遗传关系.方法 利用复合扩增技术,对15个STR基因座进行基因型分型.Arlequin 3.1软件分析群体间遗传差异和遗传距离,用邻接法构建12个群体的系统树.结果 15个STR基因座的多态信息量(polymorphic information content,PIC)为0.51～0.84,观察杂合度为0.59～0.88,期望杂合度为0.54～0.89,个人识别率(discrimination power,DP)为0.77～0.96,非父排除率(probability of exclusion,PE)为0.24～0.77.在TH01基因座,南宁汉族群体与广西回族、京族的群体间非差异exact P值均大于0.05.结论 在南宁汉族群体中,TPOX基因座的个人识别能力和非父排除能力较差,其他基因座的个人识别能力和非父排除能力较好.在南宁汉族与回族、京族之间,TH01基因座的等位基因频率分布无差异.广西各民族间存在基因交流,具有部分相同血缘,其中南宁汉族群体与壮族、侗族遗传距离较近.     

N—乙酰化转移酶基因多态与肝癌遗传易感性的研究

为探讨Ｎ－乙酰化转移酶（ＮＡＴ）基因多态与肝癌遗传易感性的关系，应用ＰＣＲ、ＡＳＰＣＲ和ＲＦＬＰ，对６５例肝癌患者和１０６例健康对照进行了研究。结果表明，病例组慢型基因频率为７０．７７％，对照组为５２．８３％，两者差异显著（Ｐ＝０．００１）。ＯＲ值为２．１６，ＥＦ值为０．３８０１。提示携带慢型基因者患肝癌的危险性增加１．１６倍，由慢型基因所致的肝癌病例占人群中全部肝癌病例的３８．０１％。病例组基因型Ｆ１／Ｆ１、Ｆ１／Ｓ和Ｓ／Ｓ的频率分别为９．２３％、４０．００％和５０．７７％，对照组则分别为２２．６４％、４９．０６％和２８．３０％，两者差异显著（Ｐ＝０．００５６）。ＯＲ值分别为１．００、２．００和４．４０，存在剂量反应关系。发现４个新的慢型基因亚型，其点突变组合为３４１／５９０、５９０／８０３、２８２／３４１／５９０、２８２／３４１，将其暂命名为Ｓ９，Ｓ１０，Ｓ１１和Ｓ１２。     

东莞地区16182名个体18个耳聋易感基因100个变异位点的测序筛查

目的确定东莞地区耳聋基因的变异类型和携带率。方法收集新生儿及门诊筛查的16182名个体,新生儿采集足跟血片,非新生儿采集外周静脉血样,对18个耳聋易感基因的100种变异进行检测。结果共检出1631例耳聋基因变异,总体检出率为10.08%,其中5例为纯合变异。SLC26A4基因变异的检出率最高(5.22%),共845例,其余依次为GJB2(673例,4.16%)、GJB3(100例,0.62%)、TMC1(12例,0.07%)、MYO15A(1例,0.01%)。GJB2基因c.235delC变异检出率最高(3.24%),共524例,其次为SLC26A4基因IVS7-2A>G变异(270例,1.67%)。33名个体(0.20%)同时携带两个变异,其中7例(0.04%)携带同一基因的复合杂合变异。结论扩大耳聋易感基因变异的筛查范围有助于了解携带情况及耳聋的遗传因素,对提早发现先天性耳聋、对受检者提供干预和遗传咨询具有重要的价值。     

胚胎植入前遗传诊断技术的应用分析

过去20年间,胚胎植入前遗传检测(PGD)主要通过卵裂球活检结合聚合酶反应(PCR)或荧光原位杂交(FISH),对胚胎的单基因遗传异常,以及有限的染色体异常进行检测。近年来PGD的活检技术以及遗传检测技术都有巨大的提高。由于囊胚球分裂稳定性高,对胚胎干扰很小以及可提供的检测细胞多等特点,囊胚球活检在PGD中的应用逐渐受到重视。新兴的遗传检测方法,微阵列-比较基因组杂交(Array-CGH)以及单核苷酸多态性微阵列(SNP-array)技术使得同时检测24条染色体成为可能,并能以更高的精度检测小片段染色体的拷贝数变化、以及结构改变等。这使得PGD应用价值不仅在于可排除遗传异常胚胎,更可用于提高大龄生育、反复流产等不孕不育人群的受孕率。     

Genetic and Environmental Mediation Between Measures of Personality and Family Environment in Twins Reared Together

In this study we analyzed the etiology of the relationship between personality traits and retrospectively recalled family environment. The data of 226 identical and 168 fraternal twin pairs reared together from the Jena twin study of social attitudes were available. Personality traits were measured using the self- and peer report versions of the German NEO-personality inventory-revised. A German version of Blocks Environmental Questionnaire was applied to measure two broad dimensions of the family environment retrospectively: support and organization. We could replicate earlier findings that retrospective reports of these family environment dimensions were in part genetically influenced. A total of 66% of the genetic variance in support and 24% in organization could be accounted for by heritable variance in self-rated personality. That was replicated by using peer reports of personality, 41% explained genetic variance in support and 17% in organization. Environmental mediations were negligible. This indicates that the relationship between personality and retrospectively recalled family environment is largely genetically mediated.

78例男性不育患者性染色体异常的细胞遗传学分析与遗传咨询

目的探讨男性不育与性染色体异常的关系，倡导心理治疗模式下的遗传咨询策略的应用。方法常规外周血淋巴细胞培养方法制备染色体标本，G显带技术进行细胞遗传学分析，必要时行c显带辅助检查。结果筛选出的78例男性不育性染色体变异中共包括8种异常核型，其中数目异常35例（44．87％），结构异常43例（55．13％），主要表现为少精或无精子症。结论性染色体异常是导致男性不育的主要因素之一；对此类患者进行心理治疗模式下的遗传咨询，解决心理困惑，提供遗传与优生咨询策略。     

Molecular analysis of Japanese patients with steroid 21-hydroxylase deficiency

We have designed a rapid and convenient strategy to determine nine of the most common mutations in the 21-hydroxylase gene (CYP21). The frequency of the mutations was investigated in 34 Japanese patients affected with congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency. We characterized 82% of the CAH chromosomes. The most frequent mutations were a C/A to G substitution in intron 2 in the salt-wasting form of the disease and an I172N in the simple virilizing form. Three de novo mutations were found. Two homozygous mutations (S268T and N493S) were detected by direct sequencing of all exons of CYP21 in two siblings, who had a normal genotype at all positions screened. We successfully applied these methods for prenatal diagnosis in one family. These procedures proved to be sensitive and rapid for the detection of the most common known mutations in the CYP21 gene and may be useful for genetic screening. Received: March 29, 1999 / Accepted: May 11, 1999