临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (1): 19-.doi: 10.3969/j.issn.1000-3606.2018.01.005

• 免疫性疾病专栏 • 上一篇    下一篇

伴皮肤症状原发性免疫缺陷病 15 例临床特征及基因分析#br#

何庭艳, 黄艳艳, 齐中香, 罗贤泽, 杨军   

  1. 深圳市儿童医院风湿免疫科(广东深圳 518038)
  • 收稿日期:2018-01-15 出版日期:2018-01-15 发布日期:2018-01-15
  • 通讯作者: 杨军 E-mail:rogasanz@163.com
  • 基金资助:
    国家卫生部公益行业科研专项(No.20140212);深圳市科技创新项目(No.JCY20160429174400950,JCY 20170303155201082)

Clinical features and genetic characteristics of primary immunodeficiency disease with skin symptoms in 15 children

HE Tingyan, HUANG Yanyan, QI Zhongxiang, LUO Xianze, YANG Jun   

  1. Department of Rheumotology and Immunology. Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China
  • Received:2018-01-15 Online:2018-01-15 Published:2018-01-15

摘要: 目的 探讨伴皮肤症状的原发性免疫缺陷病(PIDs)患儿的临床特征及基因特点。方法 回顾分析2014年1 月至2017年3月收治的15例伴皮肤症状的PIDs患儿的临床资料。结果 15例患儿的中位起病年龄为4个月(新生儿期至 11岁8个月),均出现明显的皮肤症状,包括湿疹或冻疮样皮疹、脓疱型银屑病、皮肤感染、皮下出血点或皮肤瘀斑、鱼鳞 样红皮病、早老外观及其他皮肤血管炎表现等,伴随症状包括反复感染、自身炎症、自身免疫、生长发育迟缓或淋巴增殖, 有脑、肺、肾脏等重要器官功能受损。15例患儿中, 5例嗜酸性粒细胞计数增多, 5例IgE水平升高,其中4例同时存在两项 指标异常。基因检测显示WAS、RNASEH2C、NLRP12、IL36RN、NRAS、PIK3CD、STAT1、FOXP3、STAT3、DOCK8、TYK2、 SPINK5、NBAS或ITGB2基因变异。 2例患儿死于多器官功能障碍综合征, 1例失访,其余12例存活,并在个体化治疗中。 结论 多种PIDs可出现皮肤症状,当伴有反复感染、自身炎症、自身免疫、生长发育迟缓或淋巴增殖等表现时,需警惕 PIDs可能,基因检测有助于诊断。

Abstract: Objective To explore the clinical features and genetic characteristics of primary immunodeficiency disease (PIDs) with skin symptoms in children. Methods The clinical data of PIDs with skin symptoms in 15 children from January 2014 to March 2017 were analyzed retrospectively. Results The median age at onset in 15 children was 4 months (neonatal period to 11 years 8 months). All of them showed obvious skin symptoms, including eczema or chilblain rash, pustular psoriasis, skin infections, subcutaneous hemorrhage or skin ecchymosis, ichthyosiform erythroderma, progeroid appearance, or other cutaneous vasculitis. The accompanying manifeslations included recurrent infections, auto inflammation, autoimmunity, growth retardation, or lymphoid proliferation, and impairment of brain, lung, kidney and other important organs. Eosinophil counts were increased in 5 children, IgE levels were elevated in 5 children, and 4 children were abnormal in both indicators. Gene detection showed WAS, RNASEH2C, NLRP12, IL36RN, NRAS, PIK3CD, STAT1, FOXP3, STAT3, DOCK8, TYK2, SPINK5, NBAS or ITGB2 gene mutations, respectively. Two children died from multiple organ dysfunction syndrome, 1 child was lost for follow up, the remaining 12 children survived and were under the individualized treatment. Conclusions A variety of PIDs can have skin symptoms. When accompanied by recurrent infections, auto inflammation, autoimmune, growth retardation, or lymph proliferation, PIDs should be considered, and gene detection is helpful for the diagnosis.