几种伴先天性心脏病的心血管综合征的临床识别

小儿心血管综合征常伴先天性心脏病,但临床医师常注重先天性心脏病的诊断和治疗,忽视或不重视心血管综合征的识别。临床上先天性心脏病如伴身材异常(矮小、肢体不协调)、颅面异常、语言发育落后、智力低下、骨骼异常及其他脏器异常等,需怀疑心血管综合征的存在,应行遗传咨询和诊断。     

应用3D打印技术治疗Crouzon综合征一例及文献复习

<正>Crouzon综合征是颅缝过早闭合导致的一种颅面部畸形,约占颅缝早闭症的4. 8%[1]。Crouzon综合征是颅缝早闭综合征中最常见的一种类型,手术是治疗的唯一途径,手术主要目的是扩充颅腔容积,解除早闭以及定容颅腔颅骨对大脑发育的阻碍。3D打印(3D printing)技术可以实现针对特定患者、特定需求的各种器官个性化生产。本研究采用3D打印技术,对Crouzon综合征患儿颅骨进行1∶1还原,并进行个体化手术     

FBN1基因突变致肢端发育不良的研究进展

FBN1基因突变使其编码的fibrillin-1蛋白异常, 影响肌肉骨骼的生长, 导致身材高大和身材矮小两种相反的表型, 临床表现为马方综合征和肢端发育不良。FBN1突变导致的肢端发育不良疾病包括acromicric发育不良、geleophysic发育不良和Weill-Marchesani综合征, 部分位点突变既可导致acromicric发育不良也可导致geleophysic发育不良。TGF-β信号通路失调是不同类型肢端发育不良患者的潜在致病机制。该病目前尚无特效治疗, 主要是对症治疗。早期识别症状、明确诊断、早期治疗可改善患者预后。该文将从FBN1突变致肢端发育不良的致病机制、临床表型、治疗和随访等方面进行综述。     

一例颅锁骨发育不良患儿的RUNX 2基因突变研究

目的　报告 1中国人常染色体显性遗传颅锁骨发育不良的临床病例并对其致病基因RUNX 2进行突变鉴定。方法　根据患儿的症状、体征、骨骼系统放射线检查和相关血液生化检查进行临床诊断。提取患儿外周血DNA ,PCR扩增RUNX 2编码氨基酸的 7个外显子片段 ,测序检测突变。结果　患儿 ,女 ,5岁 ,具有前囟大、双锁骨缺失、身材矮小、牙齿异常等典型颅锁骨发育不良临床表现。PCR扩增片段直接测序显示患儿RUNX 2外显子 2内发生R190W (5 6 8C >T)错义突变。该突变通过PCR产物的HaeIII限制酶切分析得到进一步确认。结论　报告一例颅锁骨发育不良病例并发现RUNX 2一复发点突变为其致病的遗传基础。     

Crouzon综合征合并生长激素缺乏症1例报告及重组人生长激素治疗随诊

目的报告1例Crouzon综合征合并生长激素缺乏症(GHD)患儿及其重组人生长激素(rhGH)治疗结果。方法回顾分析患儿以rhGH治疗2年的临床资料。结果患儿女性,5岁4月龄时身高98.2 cm(P_3),有特殊面容(舟状头、突眼、反颌畸形等)。基因检测示FGFR2基因存在c.1061CG(p.Ser354Cys)杂合变异,源自母亲,为已知的致病变异,诊断为Crouzon综合征。同时相关检查提示患儿合并GHD。给予rhGH治疗2年,身高117 cm,平均生长速率为9.4 cm/a。治疗期间,头颅磁共振监测提示侧脑室及第三脑室略扩张等表现未进展,眼科随诊示左眼视盘水肿程度较前减轻,未发现不良反应。结论矮小可能是Crouzon综合征的表型,rhGH治疗可以改善Crouzon综合征合并GHD患儿的身高,且未引起患儿颅内压增高等不良反应。     

儿童肾囊性疾病的诊治

Potter分型将儿童肾囊性疾病分为4型:常染色体隐性遗传性多囊性肾病、多囊性肾发育不良、常染色体显性遗传性多囊性肾病、梗阻性囊性发育不良肾.此外,单纯性肾囊肿、发生在肾肿瘤及其他伴囊性肾病的综合征也可引起肾脏呈囊性改变.这类病由于其发病机制和病理基础不同,临床诊断及治疗方案选择亦不同,要正确诊断这类疾病,需要仔细分类并查明病因.该文就儿童常见的肾囊性疾病进行综述.     

Alagille综合征诊断治疗进展

Alagille 综合征(Alagille syndrome, ALGS)又称为动脉-肝脏发育不良,是一种常染色体显性遗传的多系统疾病.该病患者JAG1 基因(1 型ALGS)或者NOTCH2 基因突变(2 型ALGS)导致Notch 信号通路缺陷,从而影响肝脏、心脏、眼睛、脊椎和面部等多个器官或系统.其主要的临床特征有慢性胆汁淤积、先天性心脏病、轻微椎体分割异常、特征性面容、角膜后胚胎环,以及肾脏发育不良等.该文从ALGS 的病因、发病机制、诊断和治疗等方面的进展作一综述.     

Kallmann综合征研究进展及儿科早期诊断

单纯性低促性腺激素性腺发育不良合并嗅觉障碍是Kallmann综合征（KS）的主要临床特征,其主要病理机制涉及不同基因缺陷（如KAL1、FGFR1、PROK2/PROKR2等）,导致下丘脑促性腺激素释放激素（GnRH）合成分泌障碍。根据遗传模式KS可分为X连锁、常染色体显性和隐性遗传。应重视儿科阶段KS的早期诊断,进一步探索小儿阶段的有效治疗策略。     

儿童外表畸形与疾病

一些遗传性或某些药物引发的先天性疾病,通常伴有各种颅面、皮肤、肢体畸形.及早发现这些畸形,可以为临床诊断提供有效的帮助.该文主要探讨颅面、皮肤、肢体可以被观察到的畸形及与常见综合征、代谢性疾病或基因有关疾病相关的特殊体征.     

儿童外表畸形与疾病

一些遗传性或某些药物引发的先天性疾病,通常伴有各种颅面、皮肤、肢体畸形.及早发现这些畸形,可以为临床诊断提供有效的帮助.该文主要探讨颅面、皮肤、肢体可以被观察到的畸形及与常见综合征、代谢性疾病或基因有关疾病相关的特殊体征.     

Q289P mutation in the <Emphasis Type="Italic">FGFR2</Emphasis> gene: first report in a patient with type 1 Pfeiffer syndrome

When normal development and growth of the calvarial sutures is disrupted, craniosynostosis (premature calvarial suture fusion) may result. Classical craniosynostosis syndromes are autosomal dominant traits and include Apert, Pfeiffer, Crouzon, Jackson–Weiss, and Saethre–Chotzen syndromes. In these conditions, there is premature fusion of skull bones leading to an abnormal head shape, ocular hypertelorism with proptosis, and midface hypoplasia. It is known that mutations in the fibroblast growth factor receptors 1, 2, and 3 cause craniosynostosis. We report on a child with a clinically diagnosed Pfeiffer syndrome that shows the missense point mutation Q289P in exon 8 of the FGFR2 gene. This is a mutation not previously described in the Pfeiffer syndrome but reported in the Crouzon, Jackson–Weiss, and Saethre–Chotzen syndromes. In this paper, we propose the concept that these disorders may represent one genetic condition with phenotypic variability.     

Mutation analysis of Crouzon syndrome and identification of one novel mutation in Taiwanese patients

BACKGROUND: Crouzon syndrome is an autosomal dominant disorder causing premature fusion of the cranial suture. Mutations have been reported in exon IIIa or IIIc of the fibroblast growth factor receptor 2 (FGFR2) gene. METHODS: In the present study, nine unrelated Crouzon syndrome patients were screened for mutations in the two exons of FGFR2 by polymerase chain reaction and direct sequencing. RESULTS: Mutations were detected in 67% (6/9) of all cases. More than half the studied Crouzon patients carried a mutation resulting in either the loss or gain of a cysteine residue. A novel mutation, Tyr281Cys substitution, was discovered at exon IIIa. CONCLUSIONS: The mechanisms by which the same genotypes cause different phenotypes for each type of craniosynostosis syndrome in still uncertain. However, the molecular identification of the FGFR gene has made a great impact on the clinical classification of craniosynostosis syndromes; a new classification based on genotypes seems to be unavoidable.     

Evaluation of the maxillofacial morphological characteristics of Apert syndrome infants

Apert syndrome is a rare craniosynostosis syndrome characterized by irregular craniosynostosis, midface hypoplasia, and syndactyly of the hands and feet. Previous studies analyzed individuals with Apert syndrome and reported some facial and intraoral features caused by severe maxillary hypoplasia. However, these studies were performed by analyzing both individuals who had and those had not received a palate repair surgery, which had a high impact on the maxillary growth and occlusion. To highlight the intrinsic facial and intraoral features of Apert syndrome, five Japanese individuals with Apert syndrome from 5 years and 2 months to 9 years and 10 months without cleft palate were analyzed in this study. A concave profile and a skeletal Class III jaw‐base relationship caused by severe maxillary hypoplasia were seen in all patients. The patients exhibited anterior and posterior crossbites possibly due to a small dental arch of Maxilla.     

Hydrocephalus and mental retardation in craniosynostosis

We prospectively studied craniosynostosis, regardless of neurologic status, by cranial computed tomography or psychometric testing in 56 children. None of the 27 children with simple craniosynostosis (single or multiple suture involvement) had evidence of hydrocephalus on CT scan. Of the 24 patients with simple craniosynostosis who underwent psychometric testing, 17 were of average intelligence; six were in the low average range. The single mentally retarded child had a history of severe perinatal asphyxia. Hydrocephalus occurred more frequently (five of 23 cases) in children with complex craniosynostosis syndromes, including Pfeiffer syndrome, Crouzon syndrome, and kleeblattsch?del deformity. More striking than hydrocephalus, however, was the finding of dysmorphic ventricular dilation in eight patients, including the three children with Apert syndrome and four with Crouzon syndrome. Nineteen of the 25 children with complex craniosynostosis syndromes receiving psychometric testing were of normal intelligence. Four children with borderline normal intelligence had either hydrocephalus or ventricular dilation. The two children with mental retardation were sisters with Crouzon syndrome whose family included other retarded individuals. This study indicates that the incidence of hydrocephalus and mental retardation in craniosynostosis is lower than reported previously.     

Prenatal sonographic findings and prognosis of craniosynostosis diagnosed during the fetal and neonatal periods

The aim of the study was to explore the sonographic findings of fetuses with craniosynostosis and investigate their prognosis. We conducted a 5‐year, multicenter retrospective study and collected data on patients with craniosynostosis diagnosed in the perinatal period. Of 41 cases, 30 cases (73%) were syndromic craniosynostosis, eight cases (20%) were non‐syndromic craniosynostosis and the other three cases (7%) were secondary craniosynostosis of chromosomal deletion syndromes. The prenatal ultrasound detection rate was 61%. Half of the cases of syndromic craniosynostosis detected during the perinatal period were Pfeiffer syndrome; there were also six cases of Apert syndrome, three cases of Crouzon syndrome and other rare form of syndromic craniosynostosis (Beare‐Stevenson syndrome, Saethre‐Chotzen syndrome, cranioectodermal dysplasia, and thanatophoric dysplasia). Abnormal shape of the skull was the most common finding leading to prenatal diagnosis of craniosynostosis. Abnormal head biometry, which was the second most frequent finding, was closely correlated with deformation of the cranial shape. Three cases presented with ventriculomegaly and exophthalmos but normal cranial shape and size. The overall survival rate of infants with syndromic craniosynostosis was 79%, while all of the infants with non‐syndromic craniosynostosis survived. In conclusion, prenatal diagnosis of craniosynostosis is difficult, especially when dysmorphic change of the fetal cranium is not evident. Abnormal head biometry and ventriculomegaly could potentially be additional markers of fetal craniosynostosis and consequently increase the prenatal detection rate.     

Two sisters with Bardet-Biedl syndrome: brain abnormalities and unusual facial findings

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive disorder with a wide spectrum of clinical manifestations. BBS is predominantly characterized by dysmorphic distal extremities, obesity, structural abnormalities or functional impairment of the kidney, rod cone dystrophy, and varying degrees of mental retardation. Hypogenitalism is also present, only in males, and in all cases, facial similarities. We present herein two sisters with BBS, one of whom also had cerebellar vermis hypoplasia and cerebral and cerebellar atrophy, and both of whom had ocular abnormalities in the form of epicanthus and telecanthus and metabolic syndrome. It should also be emphasized that the occurrence of cerebellar involvement such as cerebellar vermis hypoplasia and cerebellar atrophy in BBS is very unusual. The association of abnormalities in brain development and other facial features in children with BBS is not seen frequently; thus, these abnormalities should be searched carefully.     

Di George anomaly and velocardiofacial syndrome

The velocardiofacial syndrome is an autosomal dominant disorder characterized by cleft palate, cardiac anomalies, characteristic facies, and learning disabilities. The Di George anomaly involves developmental defects of the third and fourth pharyngeal pouches, resulting in thymic and parathyroid hypoplasia and cardiac defects. The cases of individuals in two families help substantiate the notion that the Di George anomaly occurs as a feature of the velocardiofacial syndrome. The proband in family 1 was a male infant with persistent hypocalcemia and cardiac defects consisting of truncus arteriosus, atrial septal defect, ventricular septal defect, and abnormal aortic arch vessels. Autopsy revealed absence of thymic and parathyroid tissue, and the Di George anomaly was diagnosed. His father had a submucous cleft palate, T cell dysfunction, and facial features consistent with the velocardiofacial syndrome. This is the third case of male-to-male transmission of velocardiofacial syndrome. The proband of family 2 was a 4-year-old girl with developmental delay, persistent neonatal hypocalcemia, ventricular septal defect, T cell dysfunction, and facial features of the velocardiofacial syndrome. The Di George anomaly has been reported to occur in at least 18 different disorders. The observation that the Di George anomaly is a component manifestation of the velocardiofacial syndrome in these two families provides further evidence that the Di George anomaly is not a distinct syndrome of a single origin but rather a heterogeneous developmental field defect. It is proposed that all previously reported cases of autosomal dominant Di George anomaly are examples of the velocardiofacial syndrome.     

Maxillo-Mandibular Development in Cerebrocostomandibular Syndrome

Cerebrocostomandibular syndrome is a potentially lethal developmental disorder characterized by mental handicap, palatal defects, micrognathia, and severe costovertebral defects. We report a 3-day-old male neonate who died of respiratory difficulty that began at birth. Micrognathia, glossoptosis, high-arched palate, and hypoplasia of the lower half of the face were present. Multiple posterior rib defects and a narrow rib cage were associated with pulmonary hypoplasia. The rib gaps were filled with fibrovascular tissue. A facial bone study showed multifocal growth retardation involving the septal cartilage, vomer, and mandibular condyle, indicative of maxillomandibular growth arrest. The tongue had an abnormal genioglossus muscle and papillae.     

Fibroblast growth factor receptor mutations and craniosynostosis: Three receptors,five syndromes

The post eighteen months have been exciting time for craniosynostosis research. In a rapid flurry of publications, mutations of fibroblast growth factor receptors (FGFRs) have been identified in three of the best known craniosynostosis syndromes, namely Apert, Crouzon and Pfeiffer syndromes, as well as in Jackson-Weiss syndrome and thanatophoric dysplasia. These findings open many new avenues for craniosynostosis research including studies of diagnosis, pathogenesis, and mutagenesis. Here the major findings and their implications have been briefly reviewed.