多巴反应性肌张力障碍的临床特点和基因诊断

目的 研究多巴反应性肌张力障碍(DRD)患者的临床特点和三磷酸鸟苷环化水解酶Ⅰ(GCH Ⅰ)基因突变.方法 对18例家族性和17例散发性DRD患者按发病年龄分为儿童期、青春期和成年期发病组,对3组患者进行病史采集、神经系统体格检查、神经心理测试和头颅CT或MRI扫描.对其中26例患者及1名无症状家族成员进行GCH Ⅰ基因的突变分析.选取35例无任何神经系统异常的健康人作为健康对照.结果 (1)儿童期发病组(15/15)、青春期发病组(6/6)与成人期发病组(7/14)比较,症状具有日间波动性者比例的差异有统计学意义(χ2=13.125,P=0.001),且症状波动性与年龄旱负相关(r=-0.720,P<0.01).(2)3组间姿势性震颤的发生率(7/15、5/6、1/14)差异有统计学意义(χ2=8.073,P=0.018),姿势性震颤发生率与患者年龄呈正相关(r=0.399,P=0.018).(3)3组患者腱反射亢进的发生率(11/15、1/6、4/14)差异有统计学意义(χ2=8.309,P=0.016),腱反射亢进发生率与年龄旱负相关(r=-0.429,P=0.010).(4)病例组汉密尔顿抑郁评分和焦虑评分均高于对照组.(5)在其中1个家系检出GCH Ⅰ基因杂合型点突变A224G.结论 DRD临床表现多样,临床表现与年龄密切相关,GCH Ⅰ基因杂合型点突变A224G可能导致发病.

Clinical characteristics and genetic diagnosis of dopa-rcsponsive dystonia

Objective To investigate the clinical characteristics and mutations of guanosine triphosphate eyclohydrolase (GCH) Ⅰ gene in patients with dopa-responsive dystonia (DRD). Methods Five families with 18 affected family members and 17 patients with sporadic DRD were examined. Patients were allocated into 3 groups according to onset time, either in childhood, or in adolescence or adult. Interview, physical examination, psychologic testings and CT/MR scan were performed. Mutation screening was performed on 26 patients and 1 normal family nember. Thirty-five healthy control subjects were matched for age and sex. Statistical analysis were conducted with the use of SPSS 13.0 computer software. Results(1)Most of patients started with dystonia. The main clinical manifestation was dystonia too. There was no difference among 3 groups.(2) There were significant differences in diurnal fluctuation among 3 groups(15/15,6/6,7/14, χ2=13.125,P=0.001). Diurnal fluctuation negatively correlated with age (r=-0.720, P<0.01).(3)The differences in postural tremor were also found among 3 groups (7/15,5/6,1/14, χ2=8.073, P=0.018). Postural tremor positively correlated with age (r=0.399, P=0.018).(4)There were differences in exaggeration of tendon among three groups(11/15,1/6,4/14, χ2=8.309, P=0.016). Exaggeration of tendon reflexes negatively correlated with age (r=-0.429, P=0.010).(5)The scores of Hamilton Depression Scale and Hamilton Anxiety Scale in patients were higher than those in controls.(6)DNA sequencing revealed a heterozygous A224G missense mutation(Tyr75Cys)located within exon 1 in one autosomal dominant inheritance family. Conclusions The manifestations of DRD varies. The clinical course is closely correlated with age. A missense mutation(A224G)in coding region of the GCH 1 gene probablyleads to the occurrence of DRD.