临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (2): 132-.doi: 10.3969 j.issn.1000-3606.2016.02.012

• 综合报道 • 上一篇    下一篇

遗传性血小板无力症的发病机制及产前诊断

李建琴1, 王兆钺2, 胡绍燕1, 赵小娟2, 曹丽娟2   

  1. 1. 苏州大学附属儿童医院血液科(江苏苏州 215003);2. 苏州大学附属第一医院 江苏省血液研究所 卫生部血栓与止血重点实验室 (江苏苏州 215003)
  • 收稿日期:2016-02-15 出版日期:2016-02-15 发布日期:2016-02-15
  • 通讯作者: 王兆钺 E-mail:zwang11@sina.com

Pathogenesis and prenatal diagnosis of hereditary Glanzmann thrombasthenia

LI Jianqin1, WANG Zhaoyue2, HU Shaoyan1, ZHAO Xiaojuan2, CAO Lijuan2   

  1. 1. Department of Hematology, Soochow University Affiliated Childern’s Hospital, Suzhou 215003, Jiangsu,China; 2. Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hematology of Ministry of Health, Suzhou 215006, Jiangsu, China
  • Received:2016-02-15 Online:2016-02-15 Published:2016-02-15

摘要: 目的 探讨血小板无力症(GT)的基因测序与产前诊断。方法 采集1 例表型GT 患儿、父母及1 例正常对照者的静脉血,患儿母亲腹中孕23 周胎儿的脐带血和羊水,及其出生2 d 时的静脉血。检测患儿、患儿父母、胎儿脐血及正常对照者的血凝常规和血小板聚集试验;流式细胞仪检测血小板膜糖蛋白(GP)IIb 和GPIIIa 的表达;微卫星技术确定胎儿脐血是否被母体细胞污染;PCR 技术扩增患儿及其父母,以及胎儿及出生2 d 静脉血GPIIb、GPIIIa 所有外显子以及外显子和内含子交界区, 扩增产物直接测序。结果 二磷酸腺苷(ADP)不能诱导患儿的血小板发生聚集,胎儿脐血中ADP 诱导的血小板最大聚集率约为正常人一半,患儿父母和胎儿出生2 d 的ADP 诱导的血小板最大聚集率与正常血小板聚集率相当。患儿血小板膜表面GPIIb、GPIIIa 的的平均荧光强度(MnX)分别约为正常对照的10% 及0,而患儿父母、胎儿脐血和胎儿出生2 d 的MnX 分别为正常对照的90% 以上和30% ~ 50%。羊水胎儿脱落细胞和脐血DNA 微卫星分析证实胎儿羊水、脐血未被母体细胞污染;基因分析结果显示,患儿GPIIIa 6 号外显子 A38293 → C 和9号外显子 G42186 → A 的杂合突变,导致GP Ⅲ aHis281 → Tyr 和Cys400 → Pro 氨基酸的杂合改变。这两个突变分别来源于父亲和母亲。羊水胎儿脱落细胞、脐血或出生2 d 静脉血中只有1 个GPIIIa9 号外显子 G42186 → A 的杂合突变。结论 GT 患儿GPIIIa 的基因为双重杂合突变;胎儿出生后确证为GP Ⅲ a 基因杂合突变。

Abstract: Objective To explore the gene sequencing and prenatal diagnosis of Glanzmann thrombasthenia (GT). Methods The blood samples were drawn from one case of phenotype GT pediatric patient, patient’s parents, and one normal control. The amniotic fluid and cord blood from the fetus of patient’s mother were collected. When the fetus was born 2 days, the blood was drawn. The coagulation routine test and platelet aggregation test were performed. The expression of platelet membrane glycoprotein (GP) IIb and GPIIIa were tested by flow cytometry. Microsatellite technology is used to determine whether fetal cord blood is contaminated with maternal cells. The expressed region and the junctional zone between exon and introns of GPIIb and GPIIIa were amplified by PCR technology from blood sample of patient, patient’s parents, and fetus’s cord and 2 days after birth. The PCR products were then subjected to DNA sequencing. Results Adenosine diphosphate (ADP) cannot induce the platelet aggregation in the patient. The max rate of the platelet aggregation in the fetus’s cord blood was half of the normal. However, the max aggregation rate induced by ADP in the blood sample of parents and fetus 2 days after birth were equal to normal. The mean fluorescence intensity (MnX) of platelet membrane GPIIb and GPIIIa in the patient were 10% and nearly zero of the normal control, respectively, while those in the parents, the fetus’s cord blood and 2 days after birth were more than 90% and 30% to 50% of the normal control. The cast-off cells in amniotic fluid and the DNA in cord blood analysis by microsatellite technology confirmed that the amniotic fluid and cord blood not contaminated by maternal cells. Gene analysis showed the heterozygosis mutation in exon6 A3829→C and exon9 G42186→A of the patient’s GPIIIa led to the amino acid heterozygosis mutation in GPIIIaHis281→Tyr and Cys400→Pro. These two mutations came from the father and the mother separately. However, there was only one heterozygosis mutation in exon9 G42186→A in the cast-off cells in amniotic fluid, the fetus’s cord and blood 2 days after birth. Conclusion This GT patient have double heterozygosis mutation. The fetus has heterozygosis mutation confirmed after birth.