临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (3): 202-.doi: 10.3969/j.issn.1000-3606.2018.03.010

• 综合报道 • 上一篇    下一篇

不典型严重联合免疫缺陷病 7 例诊治分析

贺建新, 陈兰勤, 赵宇红, 贾鑫磊, 刘钢, 徐保平, 刘秀云, 桂晋刚, 申昆玲, 江载芳   

  1. 首都医科大学附属北京儿童医院(北京 100045)
  • 收稿日期:2018-03-15 出版日期:2018-03-15 发布日期:2018-03-15
  • 通讯作者: 贺建新 E-mail:hejianxin1970@126.com
  • 基金资助:
    首都医科大学附属北京儿童医院小儿呼吸专科项目(No. 卫办医政函[2011]873号)

Diagnosis and treatment of atypical severe combined immunodeficiency disease in 7 children

 HE Jianxin, CHEN Lanqin, ZHAO Yuhong, JIA Xinlei, LIU Gang, XU Baoping, LIU Xiuyun, GUI Jingang, SHEN Kunling, JIANG Zaifang   

  1. Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, China)
  • Received:2018-03-15 Online:2018-03-15 Published:2018-03-15

摘要: 目的 探讨不典型严重联合免疫缺陷病(SCID)的诊断和治疗。方法 回顾分析2012年9月-2017年6月证 实为IL2RG、JAK3和RAG1突变的7例不典型SCID患儿的临床资料。结果 7例患儿中,婴儿5例,幼儿及学龄期儿童各1 例; 6例为男性、 1例为女性。例2、 4、 6为经典SCID临床表型,例1、 3、 5、 7为不典型SCID临床表型,例6临床诊断Omenn 综合征。例2、 5为经典SCID免疫表型,例1、 3、 4、 6、 7为不典型SCID免疫表型,例1有母体嵌合。二代测序提示,例1为 复合杂合JAK3突变c.3097-1G>A/ c.946-950GCGGA>ACinsGGT;例2、 3、 4为IL2RG突变,分别为c. 865C>T/p.R289X、 c.664C>T/R222C、52delG;例5为杂合JAK3突变c.2150A>G/p.E717G、c.1915-2A>G。Sanger测序提示,例6为复合杂合 的RAG1突变 c.994C>T/p.R332X、c.1439G>A/p.S480N;例7为纯合的RAG1突变 c.2095C>T/p.R699W。结论 SCID基 因突变在一定情况下可导致不典型的临床和/或免疫表现。

Abstract:  Objective To explore the diagnosis and treatment of atypical severe combined immunodeficiency disease (SCID). Methods The clinical data of atypical SCID in 7 children with IL2RG, JAK3, and RAG1 mutations were reviewed and analyzed from September 2012 to June 2017. Results In 7 cases (6 males and 1 female), there were 5 infants, 1 toddler and 1 school-age child. Cases 2, 4, and 6 were classic SCID clinical phenotypes. Cases 1, 3, 5, 7 were atypical SCID clinical phenotypes. Case 6 were diagnosed with Omenn syndrome. Cases 2, 5 were classic SCID immune phenotypes, cases 1, 3, 4, 6, 7 were atypical SCID immune phenotypes, and case 1 had maternal chimera. The next generation sequencing indicated that case 1 had a compound heterozygous JAK3 mutation with c.3097-1G>A/ c.946-950GCGGA>ACinsGGT. Cases 2, 3, and 4 had IL2RG mutations, with c. 865C>T/ p.R289X, c.664C>T/R222C, 52delG, respectively. Case 5 had JAK3 mutations with c.2150A>G/p.E717G and c.1915-2A>G. Sanger sequencing indicated that case 6 had a RAG1 mutation of complex heterozygosity with c.994C>T/p.R332X and c.1439G>A/p.S480N. Case 7 had homozygous RAG1 mutation with c.2095C>T/p.R699W. Conclusion Under certain conditions, gene mutation can lead to atypical clinical and/or immune phenotypic SCID.