职业卫生技术服务机构专业人员职称评定工作的思考

针对职业卫生技术服务机构专业人员职称评定工作不清晰、政策不确定的问题,在现有专业技术职称评审相关规定指引下,梳理并提出了职业卫生技术服务机构专业人员职称晋升的两种通道,便于专业人员准确合理地进行职业规划。     

家族性高胆固醇血症患者二例的LDLR基因复合杂合新突变分析

目的 探讨2例临床确诊的湖北籍FH患者的LDLR基因突变状况,为FH的基因诊断提供依据.方法 收集2例临床确诊的FH患者及其父母血脂检测指标等临床资料,通过PCR扩增LDLR基因的1～18个外显子和内含子区域,再将扩增产物进行正、反双向核苷酸序列分析,并与GenBank中LDLR基因的正常序列对比找出突变后,结合FH先证者的临床表型证实致病突变的类型.结果 氧化酶法测定1号、2号FH先证者血浆TC,分别为12.79、11.98 mmol/L;经核苷酸序列分析,其ApoB100基因涵盖的3 500～3 531区域均未见突变;LDLR基因均为复合杂合突变,1号FH先证者LDLR基因第4外显子的665位碱基G>T为杂合错义突变,且该突变为新的点突变,第9内含子的1 358+32位碱基C>T突变也为新的点突变,并均由其父母遗传.2号先证者第9外显子1 257位碱基C>A突变导致终止密码子提前出现,但其核苷酸改变与比利时报道的C>G不同,第13外显子检测到1 879位碱基G>A杂合错义突变,且分别来源于其父母.结论 2例FH先证者均存在LDLR基因复合杂合突变,1号FH先证者的第4外显子665位碱基G>T和第9内含子1 358+32位碱基C>T、2号FH先证者的第9外显子1 257位碱基C>A突变均为新突变,这可能是导致FH的分子机制.

Abstract：

Objective To determine LDLR gene mutation in 2 clinically diagnosed FH patients from Hubei province and provide basis for gene diagnosis of FH.Methods Clinical data of 2 FH patients and their parents were collected.The promoter region and exon 1 to exon 18 region of LDLR gene were amplified through PCR and the amplified products were analyzed by forward and reverse DNA sequencing.The mutations were identified after comparison with LDLR gene sequence in GenBank.The pathogenic gene mutations were confirmed according to both genotype and phenotype of FH probands.Results The levels of plasma TC of two probands were 12.79 and 11.98 mmol/L.respectively.No gene mutations were detected in region 3 500 to 3 531 of ApoB100. The mutations of LDLR gene were compound heterozygous mutations. The novel mutation 665G > T detected in the exon 4 of No. 1 proband's LDLR gene was heterozygous missense mutation. The novel mutation 1 358 +32C > T was detected in the exon 9 of No. 1 proband's LDLR gene.The mutations 665G > T ( paternal origin) and 1 358 + 32C > T ( maternal origin) were inherited from the parents. A novel mutation 1 257 C > A was detected in the exon 9 of No. 2 proband's LDLR gene, resulting the presence of a premature termination codon, which was different from 1 257 C > G reported in Belgium.Another heterozygous missense mutation 1 879 G > A was detected in exon 13. They were derived from paternal origin and maternal origin, respectively. Conclusions There are three novel gene mutations:665G >T, 1 358 +32C > T, 1 257C > A found in two probands with compound heterozygous mutations in LDLR respectively. They maybe play a potential role in FH pathogensis.