伴染色体17q获得的神经母细胞瘤3例临床分析

目的探讨伴染色体17q获得的神经母细胞瘤(NB)的临床特点及预后。方法回顾性分析我中心同期诊治的3例伴染色体17q获得的NB患儿的临床特征和近期治疗效果。NB患儿的诊断标准、肿瘤分期、临床危险度分组、治疗方案和疗效标准均根据北京儿童医院NB方案(BCH-NB-2007方案)。随访到2012年5月31日。应用FISH方法进行肿瘤组织细胞遗传学检查。结果 3例患儿确诊年龄均>18个月,病程1～6个月。原发瘤灶位于腹膜后或肾上腺,伴广泛转移,如淋巴结、骨髓、多部位骨骼转移等。INSS分期均为Ⅳ期,属高危组。3例患儿的原发瘤灶均存在染色体17q获得,无N-myc基因扩增及染色体1p缺失。均按高危NB方案治疗,1例于治疗5个月出现肿瘤进展,表现为发热、骨痛,放弃治疗。另外2例随访9个月和4个月,未见肿瘤进展或新发瘤灶。结论染色体17q获得的NB临床表现呈高度恶性,广泛转移。染色体17q获得可能与其它临床危险因素共同影响NB预后。     

伴骨髓转移的神经母细胞瘤患儿初诊时骨髓染色体核型的临床意义

目的总结伴骨髓转移的神经母细胞瘤(NB)患儿初诊时骨髓染色体核型分析结果,探讨其临床意义。方法采用G显带的方法,对2015年1月至2017年12月北京儿童医院血液肿瘤中心收治的伴骨髓转移的NB患儿进行染色体核型分析,总结临床特点、分析预后,随访至2018年12月31日。结果1.共120例患儿,男74例,女46例,≥18个月者98例(81.7%)。染色体正常组60例,其中56例(93.3%)国际神经母细胞瘤分期系统(INSS)-Ⅳ期,余4例为INSS-Ⅳs期;低危(LR)2例,中危(MR)9例,高危(HR)49例(81.7%);7例患儿MYCN基因扩增。染色体异常组60例患儿均为INSS-Ⅳ期,MR 1例,余59例(98.3%)均为HR,14例MYCN基因扩增。2.染色体异常患儿60例中单纯数目异常和结构异常者分别为4例、14例,42例患儿同时合并染色体数目及结构异常。数目异常方面,21号、10号、11号染色体缺失最为常见;结构异常方面涉及11q、1p、3p区段的异常发生率高。3.染色体正常组患儿随访时间为4~44个月,17例出现肿瘤进展或复发;染色体异常组患儿随访时间2~42个月,其中31例出现肿瘤进展或复发。所有患儿3年累积总生存率和累积无事件生存率分别为60.0%、48.4%;染色体正常组患儿3年累积生存率为74.2%,3年累积无事件生存率为65.7%;染色体异常组患儿3年累积生存率为47.5%,3年累积无事件生存率为24.9%;出现进展或复发患儿染色体数目异常以10号染色体缺失常见,结构异常以11q、1p、2p区域较多。结论NB患儿肿瘤细胞染色体异常率高,但重复率低,个体间差异明显。10号染色体缺失、11q、1p、2p区域结构异常可能为提示NB预后不良因素;通过骨髓标本进行肿瘤染色体核型分析可行,可为更精准的危险度分层和治疗提供依据。     

伴有MYCN基因扩增的神经母细胞瘤133例病例系列报告

背景：伴有MYCN基因扩增的神经母细胞瘤（NB）患儿的长期生存率不容乐观,目前国内相关大宗病例报道不多。 目的：总结伴有MYCN基因扩增的NB患儿的临床特征、治疗效果及预后相关因素。 设计：病例系列报告。 方法：纳入2007年2月1日至2020年1月30日首都医科大学附属北京儿童医院血液肿瘤中心确诊NB且经荧光原位杂交法确定伴有MYCN扩增的患儿,分析患儿瘤灶部位、大小、转移部位、肿瘤标记物、病理亚型、治疗情况及影响预后的相关因素。 主要结局指标：3年生存影响因素。 结果：纳入133例MYCN扩增的NB患儿,占同期收治总NB患儿的12.0%。男82例,女51例,中位发病年龄（35.7±9.8）个月;原发瘤灶位于腹膜后及肾上腺区129例（97.0%）,位于后纵隔区域4例（3.0%）;骨髓转移81例（60.9%）,骨骼转移80例（60.2%）,中枢转移24例（18.1%）;99例（74.4%）血清LDH≥1 500 U·L-1,126例（94.7%）神经元特异性烯醇化酶≥100 ng·mL-1;原发瘤灶最大直径≥10 cm者89例（66.9%）。3年OS和EFS分别为（19.7±3.5）%和（19.0±3.6）%。78例进展复发,在诱导、巩固、维持及停药后进展复发分别为8、20、46和4例,进展复发的部位以原发瘤灶、骨髓、中枢神经系统及骨骼最常见,中位首次进展时间为11.3月。伴有骨髓、骨转移、合并1p36缺失、年龄＜18月及未行自体外周血造血干细胞移植患儿预后不良。 结论：伴有MYCN扩增的NB患儿原发瘤灶以腹膜后肾上腺区为主,早期远处转移率高,50%以上患儿在维持治疗期间肿瘤进展,3年OS仅为19.7%。伴有MYCN扩增的NB患儿迫切需要靶向治疗等新的治疗手段,以提高疗效,改善预后。     

17q12微缺失综合征3例报告并文献复习

目的 总结儿童染色体17q12微缺失综合征的临床特征，以提高对该病的认识。方法 回顾性分析2014年10月至2021年10月收治的3例染色体17q12微缺失综合征患儿临床资料，应用二代测序技术对全基因组染色体拷贝数变异进行检测，并进行相关文献复习。结果 3例患儿中男2例，女1例。染色体17q12均发现大片缺失（分别为1.89 Mb,1.4 Mb,1.8 Mb），缺失均为新发变异；3例均有肾脏囊肿、高尿酸血症和高碱性磷酸酶；2例有单侧肾脏发育不良及蛋白尿；低镁血症2例，高胆固醇血症2例，肝酶升高1例，糖尿病2例。结论 染色体17q12微缺失综合征是一种影响多器官系统的罕见遗传性疾病，主要表现为肾脏囊肿和发育不良，也可出现糖尿病、高尿酸血症和高胆固醇血症等代谢内分泌异常。     

原发性肠淋巴瘤p53基因与13q14染色体变异与预后的关系

目的：临床发现尽管原发性肠淋巴瘤的免疫表型相同,但预后也可以截然不同,提示其预后不是单一因素所决定的,可能还与其基因或染色体的变异有关。p53基因是一种重要的抑癌基因,13q14缺失是多种淋巴细胞增殖性疾病常见的染色体异常,该研究拟探讨p53基因与13q14染色体变异在原发性肠淋巴瘤的预后判断、指导治疗中的作用,为临床治疗方案的制定提供依据。方法：采用改良的FISH技术检测了30例原发性肠淋巴瘤及10例淋巴结反应性增生患者的石蜡切片中p53基因及13q14染色体变异情况,分析其与原发性肠淋巴瘤预后的关系。结果：①Ⅰ~Ⅱ期患者中22.7%有p53基因缺失,Ⅲ~Ⅳ期患者中75.0%有p53基因缺失（χ2=6.903, P<0.01）;②MALT淋巴瘤中14.3%有p53基因缺失,非MALT淋巴瘤中56.3%有p53基因缺失（χ2=5.662, P<0.05）;③p53基因缺失者平均生存期为13.4月,明显短于p53基因正常者36.1月（t=2.637,P<0.05）;④13q14缺失在原发性肠淋巴瘤中发生率为40%,但在10例淋巴结反应性增生患者的石蜡切片中未检测到。13q14缺失与原发性肠淋巴瘤病理类型、临床分期以及平均生存期的关系不大;⑤p53基因缺失与13q14缺失无明显相关性。结论：p53基因缺失在非MALT淋巴瘤及Ⅲ~Ⅳ期患者中发生率较高。p53基因缺失的原发性肠淋巴瘤病例恶性程度高、预后差,宜早期联合化疗。13q14缺失与患者预后无明显相关性。［中国当代儿科杂志,2009,11（7）：555-558］     

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。     

45例儿童神经母细胞瘤预后因素分析

目的 分析影响儿童神经母细胞瘤（NB）的临床预后因素,期望通过综合性诊断治疗方案改善NB的预后。方法研究对象为1998年10月至2003年12月新诊断为NB患儿,根据年龄及分期分为高、中、低危3组,各组采用包括不同化疗强度的NB综合治疗方案。方案包括确切分期分组,Ⅲ、Ⅳ期患儿延迟或二次肿瘤根治术,不同强度的化疗方案和完成化疗后全顺维甲酸诱导分化治疗,高危组在化疗结束时接受自身造血干细胞移植（ASCT）。结果年龄6个月至11岁,共45例。I期9例,Ⅱ期1例,Ⅲ期8例,Ⅳ期26例,1Vs期1例。6例在≤2个疗程后好转中放弃治疗;39例按计划治疗,11例接受了ASCT。获得完全缓解（CR）31例（80％）,获得部分缓解（PR）8例（20％）。中位随访期21个月（14个月至64个月）;末次随访时CR24例（62％）,中位CR时间为22个月;带病生存病情稳定4例,总生存率（SR）72％。疾病进展、复发或已死亡11例（28％）。大于18个月、Ⅲ期及Ⅳ期明显影响预后,P分别为0．04、0．003。不同危险组预后不同,P为0．003。肿瘤原发于后腹膜,Ⅲ、Ⅳ期患儿手术未能完全切除肿瘤和未能接受ASCT者预后差,但未达统计学有效水平,P=0．092、0．55和0,60。结论NB综合整体治疗方案较为合理。年龄大于18个月、Ⅲ期及Ⅳ期为预后不良因素。肿瘤原发于后腹膜、手术未能完全切除肿瘤和未能接受ASCT预后差,但P未达统计学有效水平。     

多重连接探针扩增技术在先天性心脏病22q11微缺失/微重复综合征诊断中的应用

目的:染色体22q11区域基因拷贝数异常是先天性心脏病（CHD）的遗传病因之一,由其引起的CHD预后不良。该研究主要探讨多重连接探针扩增技术用于CHD 22q11微缺失或微重复遗传病因诊断的实用性,并了解22q11微缺失或微重复在CHD中的发生情况。方法:选择25个位于染色体22q11低重复拷贝序列A-H区域内、7个位于其周围（CES、22q13）和16个位于4、8、10、17号染色体上的基因位点共计48个探针组成多重连接探针,对181例外科手术前的CHD儿童和14例严重CHD或包括CHD的多发性畸形胎儿进行了22q11微缺失或微重复的检测,并进行了染色体核型分析。结果:195例患儿中,共检出22q11微缺失者7例（LCR A-D区6例,LCR A-C区1例）,22q11微重复1例（LCR B-D区）,涉及的CHD类型包括室间隔缺损、房室间隔缺损、肺动脉狭窄和法洛四联征。同时染色体核型分析还发现了6例异常：1例21q部分缺失［46,XY,21q-］,1例嵌合性8-三体［47,XY,+8/46,XY（1∶2）］,4例21-三体。其中1例21-三体与22q11微重复同时存在。结论:染色体22q11区域高密度多重连接探针检测技术能快速、灵敏、精确定位诊断染色体22q11区域基因拷贝数异常,适合于CHD的遗传学诊断;此外,22q11微缺失或微重复引起的CHD类型多种多样,建议所有CHD患者应常规进行遗传学检测。［中国当代儿科杂志,2009,11（11）：892-896］     

新生突变17q12微缺失综合征的I临床及遗传学分析北大核心CSCD

目的探讨生长发育迟缓并多发畸形患儿的遗传学病凶及临床表型。方法应用常规G显带技术分析1例q｜长发育迟缓并多发畸形患儿及足父母的外周血染色体,应用CytoScan750K微阵列分析患儿及父母拷贝数变异。结果患儿临床表型包括特殊阿容、身材矮小、精神发育迟缓、糖尿病等。患儿及父母常规染色体核刑分析正常。CytoScan750K微阵列分析结果检测提示：患儿arr[hg19]17q12（34822465-36410559）X1缺失1．6Mb,提示为17q12微缺久综合征,父母芯片结果正常,提示为新生突变。结论通过CytoScan750K微阵列分析确诊J,l例生长发育迟缓并多发畸形17q12微缺失患儿,为明确生长发育迟缓患儿的诊断及遗传咨询提供重要线索。     

单纯性圆锥动脉干畸形22q11.2微缺失发生率及临床表型研究

目的 探讨单纯性圆锥动脉干畸形(CTD)染色体22q11.2微缺失发生率及临床表型分析.方法 应用多重连接探针扩增法(MLPA)对77例0～10岁单纯性CTD患儿进行染色体22q11.2微缺失筛查,并对阳性样本进行荧光原位杂交(FISH)验证.采用Fisher精度检验,P＜0.05有统计学意义.结果 用MLPA对77例单纯性CTD患儿进行了22号染色体微缺失筛查,其中55例法乐四联症(TOF),4例肺动脉闭锁伴室间隔缺损(PA-VSD),8例右室双出口(DORV),10例大动脉转位(TGA).6例(7.8%)患儿存在染色体22q 11.2微缺失,其中4例为TOF,1例为PA-VSD,1例为DORV;10例TGA患儿中均未发现22q11.2缺失.结论 单纯性CTD染色体22q 11.2微缺失发生率约为7.8%.单纯性CTD患儿中,PA-VSD,DORV及TOF比TGA更易发生染色体22q11.2微缺失.应加强对单纯性CTD患儿的遗传筛查及咨询.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.