Dystrophic epidermolysis bullosa (DEB), a heterogeneous hereditary skin disorder characterized by trauma-induced blistering and scarring, affects thousands of families world wide. The clinical manifestations extend fr...Dystrophic epidermolysis bullosa (DEB), a heterogeneous hereditary skin disorder characterized by trauma-induced blistering and scarring, affects thousands of families world wide. The clinical manifestations extend from minor nail dystrophy to severe life-threatening blistering, making early molecular diagnosis and prognostication of utmost importance for the affected families. DEB is caused by mutations in the COL7A1 gene encoding collagen VII in the skin. Molecular diagnostics and genotype-phenotype correlations in DEB remain complex owing to the gene structure, large variety of mutations, high rate of novel mutations, complex protein structure and assembly, and the heterogeneity of phenotypes. Here, we report an efficient strategy for COL7A1mutation detection using direct automated DNA sequencing and implementation of software tools. With this approach, COL7A1 mutations of 41 DEB families were disclosed. Twenty-four mutations were novel and two recurrent. Elucidation of biological consequences of the mutations helped define disease mechanisms, but also revealed several unusual genotypic and/or phenotypic constellations, which impeded the diagnostics and prognostication. In addition, the studies disclosed a de novo mutation in recessive DEB and two new polymorphisms in the COL7A1 gene.展开更多
X-连锁低血磷性佝偻病(X-linked hypophosphatemic rickets,XLH)是伴X染色体显性遗传的罕见病。其临床表型差异较大,即使是同一个家系,临床表现的轻重也有所差异。这可能与位于X染色体上与内肽酶同源的磷酸盐调节基因(phosphate-regulat...X-连锁低血磷性佝偻病(X-linked hypophosphatemic rickets,XLH)是伴X染色体显性遗传的罕见病。其临床表型差异较大,即使是同一个家系,临床表现的轻重也有所差异。这可能与位于X染色体上与内肽酶同源的磷酸盐调节基因(phosphate-regulating gene with homologies to endopeptidases on X chromosome,PHEX)突变有关。本文从PHEX基因的突变类型、突变位点以及突变剂量方面,对XLH基因型和临床表型的相关性予以综述,以期为XLH的基因研究与早期临床诊疗提供依据。展开更多
目的总结Gitelman综合征患儿的临床及基因特点,以提高临床医生对儿童Gitelman综合征的认识和诊治。方法回顾性分析2013年7月~2020年12月首都医科大学附属北京儿童医院收治的有基因结果的32例Gitelman综合征患儿的临床资料,包括发病及确...目的总结Gitelman综合征患儿的临床及基因特点,以提高临床医生对儿童Gitelman综合征的认识和诊治。方法回顾性分析2013年7月~2020年12月首都医科大学附属北京儿童医院收治的有基因结果的32例Gitelman综合征患儿的临床资料,包括发病及确诊年龄、临床表现、实验室检查及基因变异情况。结果32例Gitelman综合征患儿中,男性23例,女性9例;发病年龄为5.000(3.043,7.628)岁,确诊年龄为8.776±3.528岁;确诊时身高标准差值(H-SDS)为-1.460±1.307SD;临床表现依次是肌肉无力46.9%(15/32),身材矮小37.5%(12/32),手足搐搦25.0%(8/32),多饮多尿21.9%(7/32),呕吐21.9%(7/32),腹痛和肢体麻木均为6.3%(2/32),恶心、四肢酸痛为3.1%(1/32)。实验室检查:100%患儿血钾降低,62.5%(20/32)血镁降低。血钾最低值为2.208±0.432mmol/L,血镁最低值为0.667±0.121mmol/L。血浆肾素(卧位)为12.860±7.239ng/(ml·h),血管紧张素(卧位)为536.500(235.200,700.100)pg/ml,醛固酮(卧位)为21.510(17.705,148.820)mg/L。24h尿钾为2.580±0.800mmol/(kg·24h),24h尿钙为0.020(0.010,0.055)mmol/(kg·24h),其中,血氯及24h尿钙在男女患儿中比较,差异有统计学意义(P分别为0.048和0.035)。32例患儿共检出36种不同SLC12A3变异,仅1例患儿为纯合,27例为复合杂合变异;3例患儿仅发现1个变异,1例患儿为多杂合变异。33.3%为新发变异(12/36),无义变异1例,剪切变异8种,移码变异7种,错义变异20种,最常见变异位点为p.D486N,见于31%(10/32)的患儿。所发现的变异形式在发病年龄、血电解质及肾素和血管紧张素水平比较,差异均无统计学意义,24h尿钾在剪切变异组较移码变异或无义变异组更高(2.338±0.718 vs 3.227±0.477,P=0.019)。结论Gitelman综合征发病年龄可在婴幼儿期,身材矮小是儿童Gitelman综合征的主要临床表现之一,p.D486N是最常见的变异位点。Gitelman综合征患者的基因变异和临床表现异质性很大,24h尿钾在移码或无义变异组与剪切变异组比较,差异有统计学意义。展开更多
文摘Dystrophic epidermolysis bullosa (DEB), a heterogeneous hereditary skin disorder characterized by trauma-induced blistering and scarring, affects thousands of families world wide. The clinical manifestations extend from minor nail dystrophy to severe life-threatening blistering, making early molecular diagnosis and prognostication of utmost importance for the affected families. DEB is caused by mutations in the COL7A1 gene encoding collagen VII in the skin. Molecular diagnostics and genotype-phenotype correlations in DEB remain complex owing to the gene structure, large variety of mutations, high rate of novel mutations, complex protein structure and assembly, and the heterogeneity of phenotypes. Here, we report an efficient strategy for COL7A1mutation detection using direct automated DNA sequencing and implementation of software tools. With this approach, COL7A1 mutations of 41 DEB families were disclosed. Twenty-four mutations were novel and two recurrent. Elucidation of biological consequences of the mutations helped define disease mechanisms, but also revealed several unusual genotypic and/or phenotypic constellations, which impeded the diagnostics and prognostication. In addition, the studies disclosed a de novo mutation in recessive DEB and two new polymorphisms in the COL7A1 gene.
文摘X-连锁低血磷性佝偻病(X-linked hypophosphatemic rickets,XLH)是伴X染色体显性遗传的罕见病。其临床表型差异较大,即使是同一个家系,临床表现的轻重也有所差异。这可能与位于X染色体上与内肽酶同源的磷酸盐调节基因(phosphate-regulating gene with homologies to endopeptidases on X chromosome,PHEX)突变有关。本文从PHEX基因的突变类型、突变位点以及突变剂量方面,对XLH基因型和临床表型的相关性予以综述,以期为XLH的基因研究与早期临床诊疗提供依据。
文摘目的总结Gitelman综合征患儿的临床及基因特点,以提高临床医生对儿童Gitelman综合征的认识和诊治。方法回顾性分析2013年7月~2020年12月首都医科大学附属北京儿童医院收治的有基因结果的32例Gitelman综合征患儿的临床资料,包括发病及确诊年龄、临床表现、实验室检查及基因变异情况。结果32例Gitelman综合征患儿中,男性23例,女性9例;发病年龄为5.000(3.043,7.628)岁,确诊年龄为8.776±3.528岁;确诊时身高标准差值(H-SDS)为-1.460±1.307SD;临床表现依次是肌肉无力46.9%(15/32),身材矮小37.5%(12/32),手足搐搦25.0%(8/32),多饮多尿21.9%(7/32),呕吐21.9%(7/32),腹痛和肢体麻木均为6.3%(2/32),恶心、四肢酸痛为3.1%(1/32)。实验室检查:100%患儿血钾降低,62.5%(20/32)血镁降低。血钾最低值为2.208±0.432mmol/L,血镁最低值为0.667±0.121mmol/L。血浆肾素(卧位)为12.860±7.239ng/(ml·h),血管紧张素(卧位)为536.500(235.200,700.100)pg/ml,醛固酮(卧位)为21.510(17.705,148.820)mg/L。24h尿钾为2.580±0.800mmol/(kg·24h),24h尿钙为0.020(0.010,0.055)mmol/(kg·24h),其中,血氯及24h尿钙在男女患儿中比较,差异有统计学意义(P分别为0.048和0.035)。32例患儿共检出36种不同SLC12A3变异,仅1例患儿为纯合,27例为复合杂合变异;3例患儿仅发现1个变异,1例患儿为多杂合变异。33.3%为新发变异(12/36),无义变异1例,剪切变异8种,移码变异7种,错义变异20种,最常见变异位点为p.D486N,见于31%(10/32)的患儿。所发现的变异形式在发病年龄、血电解质及肾素和血管紧张素水平比较,差异均无统计学意义,24h尿钾在剪切变异组较移码变异或无义变异组更高(2.338±0.718 vs 3.227±0.477,P=0.019)。结论Gitelman综合征发病年龄可在婴幼儿期,身材矮小是儿童Gitelman综合征的主要临床表现之一,p.D486N是最常见的变异位点。Gitelman综合征患者的基因变异和临床表现异质性很大,24h尿钾在移码或无义变异组与剪切变异组比较,差异有统计学意义。
