新生儿高胆红素血症基因变异分析：一项单中心回顾性研究

doi:10.12372/jcp.2024.23e1015

摘要/Abstract

摘要：

目的了解新生儿高胆红素血症中黄疸相关基因变异和所致疾病，及其在不同程度黄疸患儿中的分布情况。方法选择2022年7月—2023年7月在医院NICU诊断为高胆红素血症的新生儿167例，分为重度和非重度黄疸组，采用高通量二代基因测序技术进行基因检测，将黄疸基因变异者进行致病性评级，分析患儿黄疸基因变异的阳性、携带和阴性率情况；以及黄疸基因变异和所致疾病在两组患儿中的分布。结果 167例患儿中，检出黄疸基因变异阳性者18例（10.8 %），携带者55例（32.9 %），阴性者94例（56.3 %）；涉及UGT1A1、ATP7B、HBB、SLC25A13、ATP8B1、SMPD1、G6PD、SLC10A1 8个基因，其中UGT1A1基因变异频率高达45.3 %，c.211G>A为高频突变位点。重度黄疸组31例患儿中黄疸基因变异阳性16例（51.6 %），15例Gilbert综合征/Crigler-Najjar综合征均为UGT1A1基因变异；非重度黄疸组136例患儿中阳性仅2例（1.5 %），1例Gilbert综合征/Crigler-Najjar综合征系UGT1A1基因变异。比较两组黄疸基因变异阳性率、携带率和阴性率，结果显示重度黄疸组阳性率显著高于非重度黄疸组，阴性率显著低于非重度黄疸组，差异有统计学意义（P<0.014）。结论黄疸基因变异与新生儿高胆红素血症的发生和严重程度密切相关，常见病因是UGT1A1基因变异，c.211G>A为高频突变位点，对高胆红素血症患儿尤其是重度高胆红素血症进行基因检测具有重要临床意义。

关键词: 高胆红素血症, 基因检测, 变异位点, 新生儿

Abstract:

Objective To investigate the variation of genes related to neonatal hyperbilirubinemia jaundice and the diseases caused by hyperbilirubinemia jaundice, and its distribution in different degrees of jaundice. Methods A total of 167 neonates diagnosed with hyperbilirubinemia in NICU from July 2022 to July 2023 were selected and divided into severe and non-severe jaundice groups. Gene detection was performed by high-throughput second-generation gene sequencing technology. The jaundice gene variants were rated as pathogenicity, and the positive, carrying and negative rates of jaundice gene variants in children were analyzed, and the distribution of jaundice gene variation and related diseases in the two groups were also analyzed. Results Among 167 children, 18 cases (10.8%) were positive for jaundice gene variation, 55 cases (32.9%) were carriers, and 94 cases (56.3%) were negative. There were 8 genes involved in UGT1A1, ATP7B, HBB, SLC25A13, ATP8B1, SMPD1, G6PD and SLC10A1, among which the mutation frequency of UGT1A1 gene was up to 45.32%, and c.211G>A was the high frequency mutation site. In the group of 31 children with severe jaundice, 16 (51.6%) had positive results for jaundice gene mutations, and all 15 cases of Gilbert syndrome/Crigler-Najjar syndrome had UGT1A1 gene mutations. Among the 136 non-severe jaundice patients, only 2 cases (1.47%) were positive, and 1 case of Gilbert syndrome / Crigler-Najjar syndrome had a variation in UGT1A1 gene. Comparing the rates of positive, carrying and negative of jaundice gene variation between the two groups, the results showed that the positive rate of severe jaundice group was significantly higher than that of non-severe jaundice group, and the negative rate was significantly lower than that of non-severe jaundice group, with statistical significance (P<0.014). Conclusions Jaundice gene variation is closely related to the occurrence and severity of neonatal hyperbilirubinemia. The common cause is UGT1A1 gene variation, and c.211G>A is the high frequency mutation site. It is of great clinical significance to conduct gene detection for children with hyperbilirubinemia, especially severe hyperbilirubinemia.

Key words: hyperbilirubinemia, genetic testing, variation site, newborn

刘庆瑜, 王立伟, 林义临, 肖睿, 周慧, 张晓倩, 付梦冉, 米弘瑛. 新生儿高胆红素血症基因变异分析：一项单中心回顾性研究[J]. 临床儿科杂志, 2024, 42(9): 782-786.

LIU Qingyu, WANG Liwei, LIN Yilin, XIAO Rui, ZHOU Hui, ZHANG Xiaoqian, FU Mengran, MI Hongying. Genetic variation analysis of neonatal hyperbilirubinemia: a single-center retrospective study[J]. Journal of Clinical Pediatrics, 2024, 42(9): 782-786.

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基因	高频变异位点	基因型	基因变异位点(n=86)	基因变异频数(n=98)	变异频率/%
UGT1A1	c.211G>A(p.Gly71Arg)	Het	40	40	23.3
UGT1A1	c.211G>A(p.Gly71Arg)	Hom	10	20	11.6
UGT1A1	c.1091C>T(p.Pro364Leu)	Het	11	11	6.4
UGT1A1	c.1091C>T(p.Pro364Leu)	Hom	1	2	1.2
UGT1A1	c.1456T>G(p.Tyr486Asp)	Het	4	4	2.3
UGT1A1	c.914dupT(p.Ser306LeufsTer19 )	Het	1	1	0.6
ATP7B	c.3818C>A(p.Pro1273Gln)	Het	1	1	0.6
ATP7B	c.2621C>T(p.Ala874Val)	Het	1	1	0.6
ATP7B	c.2755C>G(p.Arg919Gly)	Het	1	1	0.6
ATP7B	c.3316G>A(p.Val1106Ile)	Het	1	1	0.6
ATP7B	c.3467G>A(p.Arg1156His)	Het	1	1	0.6
HBB	c.79G>A(p.Glu27Lys)	Het	1	1	0.6
HBB	c.126_129delCTTT(p.Phe42Leufs*19)	Het	1	1	0.6
HBB	c.-78A>G	Het	1	1	0.6
HBB	c.316-197C>T	Het	1	1	0.6
SLC25A13	c.852_855delTATG(p.Met285ProfsTer2)	Het	2	2	1.2
SLC25A13	IVS16ins3kb	Het	1	1	0.6
ATP8B1	c.2533A>C(p.Lys845Gln)	Het	1	1	0.6
ATP8B1	c.93_95delTGA(p.Asp31del)	Het	1	1	0.6
SMPD1	c.955C>G(p.Pro332Arg)	Het	2	2	1.2
G6PD	c.487G>A(p.Gly163Ser)	Het	1	1	0.6
G6PD	c.871G>A(p.Val291Met)	Het	1	1	0.6
SLC10A1	c.800C>T(p.S267F)	Hom	1	2	1.2

疾病	致病基因	遗传方式	基因突变位点(例数)
Gilbert综合征/Crigler-Najjar综合征	UGT1A1	AR	c.211G>A(11) c.1456T>G(2) c.1091C>T(3)
G6PD缺乏症	G6PD	X 连锁遗传	c.871G>A(1)
家族性高胆汁酸血症2型	SLC10A1	AR	c.800C>T(1)

组别	例数	阳性	携带	阴性
重度黄疸组	31	16(51.6)	8(25.8)	7(22.6)
非重度黄疸组	136	2(1.5)¹⁾	47(34.6)	87(64.0)¹⁾