遗传性血小板无力症的发病机制及产前诊断

目的探讨血小板无力症(GT)的基因测序与产前诊断。方法采集1例表型GT患儿、父母及1例正常对照者的静脉血,患儿母亲腹中孕23周胎儿的脐带血和羊水,及其出生2 d时的静脉血。检测患儿、患儿父母、胎儿脐血及正常对照者的血凝常规和血小板聚集试验;流式细胞仪检测血小板膜糖蛋白(GP)Ⅱb和GPⅢa的表达;微卫星技术确定胎儿脐血是否被母体细胞污染;PCR技术扩增患儿及其父母,以及胎儿及出生2 d静脉血GPⅡb、GPⅢa所有外显子以及外显子和内含子交界区,扩增产物直接测序。结果二磷酸腺苷(ADP)不能诱导患儿的血小板发生聚集,胎儿脐血中ADP诱导的血小板最大聚集率约为正常人一半,患儿父母和胎儿出生2 d的ADP诱导的血小板最大聚集率与正常血小板聚集率相当。患儿血小板膜表面GPⅡb、GPⅢa的的平均荧光强度(Mn X)分别约为正常对照的10%及0,而患儿父母、胎儿脐血和胎儿出生2 d的Mn X分别为正常对照的90%以上和30%~50%。羊水胎儿脱落细胞和脐血DNA微卫星分析证实胎儿羊水、脐血未被母体细胞污染;基因分析结果显示,患儿GPⅢa 6号外显子A38293→C和9号外显子G42186→A的杂合突变,导致GPⅢa His281→Tyr和Cys400→Pro氨基酸的杂合改变。这两个突变分别来源于父亲和母亲。羊水胎儿脱落细胞、脐血或出生2 d静脉血中只有1个GPⅢa9号外显子G42186→A的杂合突变。结论 GT患儿GPⅢa的基因为双重杂合突变;胎儿出生后确证为GPⅢa基因杂合突变。     

儿童遗传性血小板减少症的研究进展

遗传性血小板减少症(hereditary thrombocytopenia,HT)是一类由于遗传基因变异导致的血小板减少的出血性疾病。HT可以表现为单纯血小板减少或合并综合征,临床表现复杂,多于儿童期起病。HT的临床特点是血小板功能障碍、病程不稳定以及具有其他疾病易感性。由于致病基因的不同,HT的治疗方式和预后均不同。对于HT患儿的临床管理中出血的评估很重要,此外血小板输注、血小板生成素受体激动剂、造血干细胞移植、基因治疗也为HT治疗打开新思路。该综述总结了HT的研究进展,旨在帮助临床医生全面识别HT,采取积极有效的治疗方案。     

遗传性球形红细胞增多症发病机制、诊断及治疗进展

遗传性球形红细胞增多症（hereditary spherocytosis,HS）是红细胞膜异常所致的溶血性贫血中最常见的类型,属遗传性溶血性贫血。本文就HS的病理生理机制和临床特点作简要介绍。     

原发性血小板增多症发病机制研究进展

原发性血小板增多症(ET)是一种以巨核细胞系增生为主的多能造血干细胞克隆性疾病.儿童与成人疾病特征类似,主要表现为血小板持续性增多,伴有出血、血栓形成,肝脾轻至中度肿大.研究表明ET的发病与多种基因、微小RNA、免疫分子的表达异常或失调及一些染色体异常等相关.该文综述了ET发病机制在分子生物学、免疫学、细胞遗传学等领域...     

血小板无力症3例

例1，女，4岁，哈族，皮肤有瘀斑。出血时间1min，凝血时间（试管法）9min，血小板200×109／L，血小板聚集：1分钟9％，5分钟15％。例2，男，8岁，汉族，有反复鼻蛆病史，皮肤有瘀斑，出血时间1min，凝血时间（试管法）10min，血小板180×109／L，血小板聚集：1分钟2％，5分钟     

小儿血小板无力症22例临床分析

血上板无力症（glanzmann thrombsathenia,GT) 为遗传性血小板功能缺陷中最为常见的疾病,是血小板膜糖蛋白ＩＩb/ＩＩIa/IIIa)数量减少或结构异常所致的出血性疾病^[1]。下面根据１９８６年后的标准诊断总结我科１９８３－１９９９年门诊及病房共２２例ＧＴ资料^[2]。     

流式细胞术快速确诊小儿血小板无力症

血小板无力症(glanzmann’s thrombasthenia,GT)是一种罕见的常染色体隐性遗传性疾病,其发病机理是由于血小板膜纤维蛋白原受体GPⅡb／Ⅲa糖蛋白缺乏,使血小板不能聚集所致。临床主要表现为反复出血。血小板糖蛋白GPⅡb／Ⅲa归属于CD41a／CD61,采用抗人CD41a／CD61和流式细胞术(FCM)能从分子水平对GT作出明确诊断。最近本     

血小板无力症患者出血机制的初探

目的探讨血小板无力症(glanzmann’s thrombasthenia,GT)患者血小板聚集功能异常的可能机制。方法采用流式细胞仪检测血小板糖蛋白Ⅱb(GPⅡb,CD41)/Ⅲa(GPⅢa,CD61)含量,并通过血小板聚集试验、血小板黏附试验、血块收缩试验对血小板功能的检测。结果GT患者血小板糖蛋白Ⅱb(GPⅡb,CD41)/Ⅲa(GPⅢa,CD61)含量明显低于正常,血小板聚集试验、血小板粘附试验、血块收缩试验明显较正常低下,出血时间较正常明显延长。结论血小板GPⅡb/Ⅲa量的减少及功能障碍是导致血小板无力原因,可能机制与其相关基因突变有关。     

儿童免疫性血小板减少症发病机制研究进展

免疫性血小板减少症(immune thrombocytopenia,ITP)是一种由自身免疫介导的出血性疾病,其特点为血小板破坏增多和生成不足.ITP发病机制复杂多样,具有异质性,至今尚未完全明确,在儿童中尤其突出.现有研究表明,免疫失耐受引起各种免疫细胞或分子异常,进而导致血小板破坏增多或生成不足,是ITP的核心发病...     

遗传性血小板功能障碍的诊断和治疗现状

遗传性血小板功能障碍(IPFD)是一种罕见的遗传性疾病,临床上以不同程度的出血倾向伴或不伴血小板减少为主要表现。以往由于实验室缺乏标准化评估体系,IPFD的诊断及分类困难,导致该类疾病的发病率可能被低估。目前,结合临床表现和实验室检测及二代测序技术,有助于及时、准确地诊断这类复杂的出血性疾病,并给予及时的病情评估及治疗...     

Spontaneous haemothorax: an uncommon presentation of Glanzmann thrombasthenia

Glanzmann thrombasthenia is a rare hereditary qualitative platelet disorder characterized by a lifelong bleeding tendency due to quantitative and qualitative abnormalities of the platelet integrin alpha(IIb)beta3. Common clinical manifestations include purpuric type skin bleeding, prolonged bleeding from minor cuts, epistaxis, gingival bleeding and menorrhagia. Less frequently, gastrointestinal system bleeding may occur. Haemarthrosis, haematuria, intracranial and visceral haemorrhage are very rare symptoms. This study reports a 3-y-old girl with Glanzmann thrombasthenia who presented with life-threatening haemothorax. There was no history of recent trauma or drug usage and no vascular or parenchymal abnormalities to explain the development of haemothorax. Conclusion: To the authors' knowledge this is the first case of Glanzmann thrombasthenia complicated by spontaneous haemothorax.     

Sustained engraftment post bone marrow transplant despite anti-platelet antibodies in Glanzmann thrombasthenia

BACKGROUND: Patients with Glanzmann thrombasthenia (GT) have normal platelet counts but abnormal platelet aggregation and carry the risk of life-threatening bleeding. We report three patients who received bone marrow transplantation (BMT) for type I GT and discuss the risk and management of anti-platelet antibodies. PATIENTS AND RESULTS: Diagnosis of GT was made through abnormal platelet aggregation studies or the absence of GPIIb/IIIa by flow cytometry. All patients had severe bleeding requiring multiple red blood cell transfusions. One patient received an unrelated donor transplant and two received matched sibling donor transplants following conditioning therapy with busulfan, cyclophosphamide, and fludarabine. Two patients developed an anti-platelet antibody, treated in one with intravenous immune globulin (IVIG). Engraftment of white blood cells and platelets was achieved on day +13 to +14 and +17 to +25, respectively. Complete donor chimerism and GPIIb/IIIa+ platelets are sustained at +22 to +30 months post transplant. CONCLUSIONS: In summary, patients with GT and history of severe hemorrhage can be cured with BMT, but the presence of anti-platelet antibodies should be sought and platelet transfusions minimized prior to transplant. IVIG may be helpful in cases of refractory immune thrombocytopenia related to anti-platelet antibodies. Improvement in transplant-related complications with current transplant regimens allows consideration of BMT for life-threatening non-malignant disorders such as GT.     

Novel and recurrent mutations of ITGA2B and ITGB3 genes in Korean patients with Glanzmann thrombasthenia

Glanzmann thrombasthenia (GT) is an autosomal recessive bleeding disorder caused by defective glycoprotein, αIIb and β3, encoded by ITGA2B and ITGB3 genes, respectively. We herein describe four unrelated Korean patients with genetically confirmed GT. Two patients were homozygous for c.1913+5G>T (IVS11+5G>T) mutation of ITGB3 with a signature of founder effect. The other two patients were compound heterozygous for two mutations of ITGA2B: c.[2333A>C];[2975delA] (p.[Q778P];[E992Gfs*30]) and c.[1750C>T];[2333A>C] (p.[R584X];[Q778P]). The c.2975delA mutation was a novel frameshift mutation of ITGA2B. Although from a limited number of patients, these results suggests c.1913+5G>T of ITGB3 is a recurrent mutation in Korean patients with GT.     

非典型溶血尿毒综合征发病机制和治疗研究进展

非典型溶血尿毒综合征(atypical haemolytic uraemic syndrome,aHUS)是一种补体失调性疾病,补体调控蛋白H因子、I因子,以及膜辅助蛋白和血清补体固有成分(B因子、补体C3)的基因突变都可参与其发病,病情易反复,预后很差,25%的患者在急性期死亡,50%以上发展为终末期肾病。因此aHUS的发病机制及治疗一直是研究热点,文章就这两个方面的研究进展作了综述。     

An update in prevention and treatment of pediatric obesity

Background  Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This “globesity” also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood. Data sources  Identification of pediatric population at risk which is the one with an rBMI of 111%–120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach. Results  A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies. Conclusions  Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.     

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肺炎支原体(mycoplasma pneumoniae,MP)是儿童社区获得性呼吸道感染的重要病原。传统观念认为,MP感染呈自限性经过,但近年来在临床实践中发现重症MP肺炎明显增多,治疗效果显著下降[1-2]。目前治疗中的困境与MP肺炎复杂的发病机制有关。本文就目前对MP肺炎发病机制的研究现状及其治疗对策作一探讨。     

噬血细胞性淋巴组织细胞增多症发病机制及诊疗新进展

噬血细胞性淋巴组织细胞增多症(HLH)是一类罕见的、严重威胁生命的,由原发或继发性免疫异常导致的过度炎症反应综合征。淋巴细胞、单核细胞和巨噬细胞系统异常激活、增殖,分泌大量炎性细胞因子而引起的一系列炎症反应是其主要的致病机制。本文旨在对HLH的发病机制及诊疗新进展进行系统性阐述。     

An update on Kawasaki disease II: Clinical features,diagnosis, treatment and outcomes

This is the second of two updates on Kawasaki disease. The first review focused on epidemiology and aetio‐pathogenesis. Here, we review the clinical features and diagnosis of Kawasaki disease, as well as recent evidence on treatment, follow‐up and cardiovascular outcomes.