临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (6): 424-.doi: 10.3969/j.issn.1000-3606.2018.06.006

• 泌尿系统疾病专栏 • 上一篇    下一篇

肾脏受累的 Cockayne 综合征临床特点、治疗及随访观察

刘晓宇, 汤泽中, 王芳, 张宏文, 陈志慧, 姚勇, 丁洁   

  1. 北京大学第一医院儿科(北京 100034)
  • 收稿日期:2018-06-15 出版日期:2018-06-15 发布日期:2018-06-15
  • 通讯作者: 汤泽中 E-mail:tangzz308@163.com
  • 基金资助:
    国家重点研发计划精准医学研究重点专项课题(No.2016YFC0901505);儿科遗传性疾病分子诊断与研究北京市重点 试验室(No.BZ0317)

Clinical characteristics, treatment and follow-up of Cockayne syndrome with renal involvement

 LIU Xiaoyu, TANG Zezhong, WANG Fang, ZHANG Hongwen, CHEN Zhihui, YAO Yong, DING Jie   

  1. Department of Pediatric, Peking University First Hospital, Beijing 100034, China
  • Received:2018-06-15 Online:2018-06-15 Published:2018-06-15

摘要: 目的 探讨Cockayne综合征肾脏受累的临床特征及其治疗和随访。方法 回顾分析1例经基因检测确诊 的Cockayne综合征伴肾脏损伤患儿的临床资料,并复习文献,总结Cockayne综合征肾脏受累的临床特征。结果 患儿 男性, 3岁8个月,主要临床表现为精神运动发育迟滞、生长发育障碍、特殊面容、光敏性皮炎,肾脏受累表现为肾病综 合征;头颅CT显示双侧基底节对称性钙化。靶向二代测序结果显示,患儿ERCC8基因(NM_000082)c.394_398del, p.Leu132AsnfsTer6,纯合突变,患儿父母均检测到相同杂合突变(父母非近亲婚配)。 诊断肾病综合征后,给予足量泼尼 松试验性治疗,患儿尿蛋白减少但未转阴,符合激素耐药,联合环孢素治疗4个月后尿蛋白转阴,随访20个月,尿蛋白持 续阴性,肾功能维持稳定。Cockayne综合征肾病受累的文献报道少,临床表现异质性大。结论 需注意Cockayne综合征患 儿表现为肾病综合征等的肾脏受累。

Abstract:  Objective To explore the clinical features, treatment and follow-up of Cockayne syndrome with renal involvement. Method The clinical data of one child with Cockayne syndrome confirmed by gene detection with renal injury were reviewed, and the clinical features of renal involvement in Cockayne syndrome were summarized. Results A male child aged 3 years and 8 months had clinical manifestations of mental retardation, growth retardation, special face and photosensitive dermatitis, and renal involvement was manifested by nephrotic syndrome. Cranial CT showed symmetrically calcification in bilateral basal ganglia. The targeted next generation sequencing results showed homozygous mutations of c.394_398del and p.Leu132Asnfs in ERCC8 gene (NM_000082) of the child, and the same heterozygous mutation was found in both his parents (non-consanguineous marriage). After the diagnosis of nephrotic syndrome, full dose prednisone was given for experimental treatment. The urine protein decreased but did not disappear, which was considered hormone resistance. After 4 months of combined treatment with cyclosporin, the urine protein turned negative. During 20 months of follow-up, urine protein remained negative and renal function remained stable. The renal involvement in Cockayne syndrome was seldomly reported, and its clinical manifestations are heterogeneous. Condusion Renal involvement in Cockayne syndrome may be manifested  with nephrotic syndrome which should be noticed.