婴儿神经轴索营养不良1例临床和基因变异分析

目的 探讨婴儿神经轴索营养不良(INAD)的临床特点和PLA 2 G 6基因变异特征.方法 回顾分析1例经基因检测确诊的INAD患儿的临床资料.结果 患儿,女性,2岁.1岁7个月发病,临床表现为精神运动发育倒退、肌张力减低、病理征阳性.头颅磁共振成像(MRI)示双侧小脑萎缩;肌电图未见异常;2 h视频脑电图未见异常.基...     

两例同胞婴儿神经轴索营养不良临床特征及PLA2G6基因分析

目的探讨婴儿轴索营养不良(INAD)的临床特点及PLA2G6基因变异特征。方法回顾分析同患INAD的同胞姐弟的临床资料并分析PLA2G6基因变异。结果弟弟于2岁4个月、姐姐1岁2个月发病,起病前发育无异常,均以运动功能及语言功能倒退为主要表现。弟弟进展更快,3岁失去行走功能,5岁失去语言功能。姐姐进展较慢,5岁失去行走能力及语言能力。均有明显的肌张力增高及痉挛性瘫痪,但视力、听力及认知减退较轻;均发现小脑明显萎缩,累及蚓部及半球,姐姐可见苍白球铁沉积(T2像及FLAIR对称性高信号)。基因检测发现PLA2G6基因均发生c.1993AG (遗传自父亲)和c.28dupA(遗传自母亲)杂合变异,为复合杂合突变。c.1993AG变异导致第665号氨基酸由蛋氨酸(Met)变为缬氨酸(Val)(p.Met665Val),为错义变异。c.28dupA变异导致从第10号的苏氨酸(Thr)开始的氨基酸合成发生改变,并在改变后的第11个氨基酸终止(p.Thr 10Asnfs Ter11),为移码变异。三种软件预测上述变异均可导致蛋白质功能受到影响。结论发现PLA2G6基因的新突变位点c.1993AG,可能与已知致病突变c.28dupA共同导致常染色体隐性遗传病INAD的发生。扩大了中国INAD患者的基因突变谱。     

婴儿神经轴索营养不良临床与分子遗传学研究

目的 分析中国婴儿神经轴索营养不良患儿的临床及遗传学特点,为在国内开展此病的准确分子诊断提供科学依据,为将来给患者家庭提供准确的遗传咨询及产前检查打基础.方法 2003-2007年北京大学第一医院按照Aicardi和Castelein提出的临床诊断标准收集病例.对收集到的病例,进行(1)临床特点分析包括病史、体征、辅助检查特点;(2)PLA2G6基因突变分析对临床诊断婴儿神经轴索营养不良的患儿进行PIA2G6基因直接测序,阳性发现者进行酶切验证,并进一步对患儿父母进行检测.如发现的突变是未见报道的新突变,则对50例正常人DNA进行该突变的检测.结果 共收集该病例3例.临床特点7个月至2岁起病,进行性智力、运动倒退,无惊厥发作;3倒均双侧锥体束征( );头颅MRI均提示明显小脑萎缩,2例系列MRI复查提示脑萎缩呈进行性;所有病例肌电图均提示神经源性改变;2例行活检者(皮肤、腓肠神经或肌肉)可见巨大神经轴索.遗传学分析3例患者中共发现PLA2G6基因的5种突变,其中4种为国外未报道过的新突变,均位于高度保守区,50例正常对照中均未发现上述突变.5种突变分别为c.1A＞G(起始密码异常);c.109C＞T(R37X),无义突变;c.1111G＞ A(V371M);c.1117G＞A(G373R);c.1633A＞C(K545E).患者均为复合杂舍突变,除1例无父母标本外,2例患者的突变均分别来自其父母双方之一.结论 本研究在国内首次通过遗传学方法确诊了婴儿神经轴索营养不良,并且发现了4种国际上未见报道的新突变.上述PLA2G6基因突变检测结果明显扩展了该基因的突变谱(目前国外共报道突变仅40余种).基因突变检测较肌肉活检具有创伤小、准确性高的特点,因此有望将来以检测PLA2G6基因突变代替神经肌肉活检确诊婴儿神经轴索营养不良,并可以为患儿家庭提供遗传咨询和产前诊断.     

婴儿神经轴索营养不良的临床特点及PLA2G6基因分析

婴儿神经轴索营养不良（INAD）是一种罕见的神经退行性疾病。该文报道2例男性患儿,年龄分别为3岁、4岁2个月,均以精神运动发育落后/倒退就诊,出生史无异常,目前肌力、肌张力均低下,其中1例患儿已不能独站,且视力下降。肌电图示神经源性损害;头颅MRI示小脑萎缩。全外显子组测序发现2例患儿PLA2G6基因均存在复合杂合突变,其中1例患儿携带的IVS11-1G > T、c.1984C > G突变为新突变,免疫组化示该患儿肌肉组织中PLA2G6蛋白表达量降低。INAD主要临床表现为精神运动发育落后/倒退、小脑萎缩等,基因测序可协助临床确诊。     

婴儿神经轴索变性一例

患儿男,3岁,主因“智力运动落后伴倒退2年余”入院。患儿4月龄前智力运动发育正常(可竖头,逗笑、伸手抓物),之后发育渐落后,7月龄时可扶坐,1岁时可独坐片刻、扶站,1岁2个月时可扶走,无自主语言发育。此后智力运动开始倒退,以1岁9个月后为著,至2岁时完全丧失主动运动,对外界刺激包括光、声反应性差,无主动追光、追声表现。可吞咽流食,常呛咳,不会咀嚼。病程中无惊厥发作。     

非钙依赖型磷脂酶A2相关性神经变性病5例并国内文献复习

目的 探讨国内非钙依赖型磷脂酶A2相关性神经变性病(PLAN)临床表型和PLA2G6基因型特点.方法 回顾性收集2016年6月至2019年5月复旦大学附属儿科医院确诊PLAN患儿的临床资料,并以"PLA2G6"和"脑组织铁沉积神经变性病"为检索词在"中国知网、万方、维普、Pubmed"数据库检索2006年1月至2020...     

额叶皮质发育不良婴儿神经精神发育随访分析

目的　评估新生儿缺氧缺血性脑病 (HIE)所致额叶皮质萎缩在神经精神发育方面的预后。方法　自1997年 4月至 1999年 9月对 5 18例额叶皮质发育不良患儿在抽搐发作、睡眠行为、注意能力、语言发育、神经运动、依恋情感和认知水平方面定期评价至 3岁龄。结果　 4月龄后发生无热抽搐 86例 (16 6 % ) ,在 18～ 30月龄间出现热性惊厥 2 6例 (5 0 % )。 4月龄出现 1项以上睡眠异常 2 5 6例 (49 4 % ) ,18月龄有 2～ 3项睡眠异常 5 3例 (10 2 % )。 8月龄注意能力异常 194例 (37 5 % ) ,3岁龄 6 8例异常 (13 3% )。 18个月龄运动性语言发育迟缓15 6例 (30 1% ) ,在 3岁龄时 ,运动性语言发育落后或构音异常 6 9例 (13 3% )。 4～ 8月龄期间 ,运动发育持续迟缓 4 2 6例 (82 2 % ) ,平均得 78 2分。 3岁龄运动发育迟缓者 14 1例 (2 7 2 % ) ,其中脑性瘫痪 32例。在 15月龄 2 4例 (4 6 % )依恋情感发展落后。结论　额叶皮质发育不良预后良好 ,但部分可能有远期的后遗症。应在婴儿早期常规检查头部CT或MRI。有额叶皮质发育不良者 ,需定期检查评价神经运动、精神发育、注意能力、语言发育水平和睡眠行为、依恋情感、脑电图等。     

婴儿神经母细胞瘤51例诊疗特点及长期随访分析

目的 分析初诊年龄<12月龄神经母细胞瘤（NB）患儿的临床特征、诊疗特点及远期疗效。方法 回顾性分析2008年1月至2018年12月收治的NB患儿的临床资料,总结其临床特点及预后影响因素。结果 51例NB患儿中,男34例、女17例,中位诊断年龄7.5(3.8～10.1)月龄,腹部肿块（27例,52.9%）是最常见的就诊原因。原发部位主要为肾上腺（21例,41.1%）及后腹膜（19例,37.2%）,骨髓、肝脏及骨是最常见的转移部位。MYCN基因扩增频率为11.3%(5/44)。49例患儿行手术治疗,其中8例单纯手术治疗,13例化疗后行手术治疗,28例化疗前行手术治疗;1例仅行化疗,1例随访观察。中位随访时间为78.5(72.1～124.0)月龄,共49例无事件生存,2例死亡。6年总体生存率和6年无事件生存率均为（96.1±2.7）%。单因素分析提示肿瘤分期、远处转移、骨髓转移、骨转移、危险度分组、MYCN基因扩增、初诊时血清神经元特异性烯醇化酶和乳酸脱氢酶水平是影响预后的因素（P<0.05）。结论 婴儿NB患者长期预后好,无MYCN基因扩增的患儿有望进一步降低化疗强度。     

婴儿良性癫癎38例临床跟踪随访观察

目的　观察婴儿良性癫临床发作 ,通过 6～ 15个月临床随访 ,探讨婴儿良性癫的诊断及治疗。方法　收集 2 0 0 2年 2月～ 2 0 0 3年 1月来我院神经专科门诊及病房就诊癫患儿临床资料 ,其中 38例符合婴儿良性癫诊断 ,年龄 3～ 2 4个月 ;男∶女为 17∶2 1,进行随访观察。结果　 2 7例单药治疗 ,其中 2例首次就诊未治疗 ,再发作后选择治疗 ;11例未治疗 ;2例服药 6个月后停药 ;均经 6～ 15个月随访 ,所有患儿临床发作停止 ,智能正常。结论　婴儿良性癫临床并不少见 ,预后好 ;对不愿治疗患儿应严密观察     

婴儿良性癫癎的临床观察和远期随访研究

目的 研究婴儿良性癫痫的发作特征,脑电图及治疗反应,探讨早期诊断方法。方法 对出生后3-24个月内起病,排除热性惊厥,症状性癫痫及发育异常的婴儿惊厥进行临床观察及寻像脑电图（VEEG）监测,并随访治疗效果和远期预后,结果 42例经2年以上随访确诊为婴儿良性癫痫,其中3例有良性婴儿惊厥家族史,19%惊厥伴有轻微腹泻,67%为短期内频繁发作,无癫痫持续状态,3例VEEG监测证实分别为起源于颞区,枕区及多灶性的部分性发作,发作间期脑电图背景正常,24%睡眠中有Rolandic区小棘波,39例接受抗癫痫单药治疗,平均用药时间9个月,3例未用药物治疗,起病1年内发作均消失,结论 起病早期具有以下特征应考虑有婴儿良性癫痫的可能;（1）起病年龄在3-12个月,不超过24个月,可有婴儿良性惊厥家族史;（2）发病前后精神运动发育正常;（3）发作无诱因,或仅有轻度腹泻等非特异性感染;（4）以部分性发作为主,可继发全身性发作,起病时发作可以很频繁,但无癫痫持续状态;（5）发作间期脑电图背景正常,无典型癫痫样放电,可有睡眠期Rolandic区小棘波;（6）神经影像学正常。     

Histopathological Study of the Biopsied Muscles from Juvenile Patients with Congenital Myotonic Dystrophy

Histopathology and histochemistry were studied in biopsied muscles from eight patients with the congenital form of myotonic dystrophy (congenital MyD) and one patient with the adult form (adult MyD). In the muscle pathology of the four patients aged between 5 and 11 years with congenital MyD, there was no immaturity of the fibers and the histological alterations were minimal. The pathological findings of the adult patient with congenital MyD resembled those of adult MyD. The immature condition of the musculature observed during the early infantile period, therefore, may once improve with motor development during childhood and, after that, the muscle fibers may degenerate in a similar manner to that seen in adult MyD. Two patients with marked talipes equinovarus displayed grouped atrophy. Small angular fibers and pyknotic nuclear clumps were observed in five patients. These findings suggest that some neurogenic factor might be involved in the muscular changes in this disorder.     

Infantile seizures and other epileptic phenotypes in a Chinese family with a missense mutation of KCNQ2

Introduction Benign familial infantile seizures (BFIS) is a form of idiopathic epilepsy characterized by clusters of afebrile seizures occurring around the sixth month of life and a favorable outcome. Linkage analysis has revealed that three chromosomal segments, 19q12-q13.1, 16p12-q12, and 2q23-31, are linked to this disorder.Subjects and methods We report here a large Chinese family in which all 17 affected members had had infantile seizures with onset at age 2–4 months, with two of these also manifesting seizures later in life accompanied with either choreoathetosis or myokymia. Linkage analysis in this family confirmed a previous report of genetic heterogeneity in BFIS – since linkage was excluded at the above-mentioned known BFIS loci – and suggested a possible linkage to the KCNQ2 gene, which is believed to be a voltage gated potassium channel gene responsible for benign familial neonatal seizures (BFNS).Results and discussion Sequencing of the KCNQ2 gene revealed that all 17 affected family members carried a heterozygous Gly-to-Val (G271V) mutation in the conserved pore region that resulted from a guanine-to-thymine transition in exon 5 of KCNQ2. The same mutation with a comparable localization in the KCNQ3 (G310V) gene has been found in BFNS patients. The same conserved amino acid was also found to be mutated in the KCNQ1 gene in a family with Long QT Syndrome.     

进行性肌营养不良的神经电生理检测

目的探讨神经电生理检测对小儿进行性肌营养不良(PMD)的诊断价值。方法对32例PMD患儿的临床特征及实验室资料进行分析,并作针极肌电图(EMG)及神经传导(NCV)检测。观察静息状态时自发电位,测定轻收缩时运动单位电位(MUP)的时限、波幅,大力收缩时的幕集相。测定运动、感觉神经的传导速度(MCV、SCV)及动作电位的末端潜伏期(ML)、波幅(AMP)。结果PMD患儿32例自发电位的异常率为49.2%,胫前肌达80.9%,MUP时限缩短了29.7%～62.4%,大力收缩时波幅降低,与正常值比较有显著差异(P<0.01)。动作电位的ML轻度延长3.70%,AMP降低5.56%。结论神经电生理检测在PMD患儿的诊断、鉴别诊断及早期诊断中有重要意义。     

The Development of Laboratory Animal Science for the Study of Human Muscular and Nervous Diseases in Japan*

Abstract Investigations by using animal models offer a useful tool to study the pathogenesis and cure of several incurable human diseases. The laboratory animal science in this field was established about 20 years ago in Japan. This paper describes the outline of its history and the characteristics of each animal model which has been studied extensively and will also be studied in the future in Japan. Some results on dystrophic chicken and gracile axonal dystrophic (gad) mouse which were recently obtained in our laboratory are discussed.     

Safety and Efficacy of Carvedilol Therapy for Patients with Dilated Cardiomyopathy Secondary to Muscular Dystrophy

Background By the age of 20 years, almost all patients with Duchenne’s or Becker’s muscular dystrophy have experienced dilated cardiomyopathy (DCM), a condition that contributes significantly to their morbidity and mortality. Although studies have shown carvedilol to be an effective therapy for patients with other forms of DCM, few data exist concerning its safety and efficacy for patients with muscular dystrophy. This study aimed to evaluate the safety and efficacy of carvedilol for patients with DCM. Methods A clinical trial at an outpatient clinic investigated 22 muscular dystrophy patients, ages 14 to 46 years, with DCM and left ventricular ejection fraction (LVEF) less than 50%. Carvedilol up-titrated over 8 weeks then was administered at the maximum or highest tolerated dose for 6 months. Baseline and posttreatment cardiac magnetic resonance imaging (CMR), echocardiography, and Holter monitoring were recorded. Results Carvedilol therapy was associated with a modest but statistically significant improvement in CMR-derived ejection fraction (41% ± 8.3% to 43% ± 8%; p < 0.02). Carvedilol also was associated with significant improvements in both the mean rate of pressure rise (dP/dt) during isovolumetric contraction (804 ± 216 to 951 ± 282 mmHg/s; p < 0.05) and the myocardial performance index (0.55 ± 0.18 to 0.42 ± 0.15; p < 0.01). A trend toward improved shortening fraction, E/E’ ratio, and isovolumetric relaxation time also was observed. Two patients had runs of nonsustained ventricular tachycardia exceeding 140 beats per minute (bpm) before carvedilol administration. Ventricular tachycardia exceeding 140 bpm was not observed after carvedilol therapy. Carvedilol was well tolerated, and no serious adverse events were identified. Conclusions Carvedilol therapy appears to be safe for patients with DCM secondary to muscular dystrophy and produces a modest improvement in systolic and diastolic function.     

Clinical and Histopathological Study of Merosin-deficient and Merosin-positive Congenital Muscular Dystrophy

The clinical features of merosin-positive congenital muscular dystrophy (CMD) and merosin-deficient CMD are well known, with those of merosin-deficient CMD being more severe. Whether the severity of histopathological findings correlates with these clinical features remains unanswered. In this study, the clinical and histopathological findings of 39 merosin-deficient and 37 merosin-positive CMD patients were compared. Merosin-deficient CMD patients were found to be younger, with earlier onset of symptoms, age of diagnosis, and a more severe clinical state (reflecting maximum motor capacity and contractures). On histopathological evaluation, endomysial fibrosis, perimysial fibrosis, and histopathological state (reflecting fibrosis, adiposis, necrosis, and variation in fiber size) were more severe in merosin-deficient CMD. There was a correlation between clinical and histopathological states only in merosin-deficient CMD. Received January 15, 1999; accepted April 7, 1999.