临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (12): 916-.doi: 10.3969/j.issn.1000-3606.2018.12.008

• 综合报道 • 上一篇    下一篇

新生儿慢性肉芽肿病 1 例临床及基因分析

沈君, 熊雨美, 彭秋琰, 刘光明, 龚云, 吴金霞, 杨好妹, 卢嘉铭, 李佩青   

  1. 广州市妇女儿童医疗中心 (广东广州 510120)
     
  • 收稿日期:2018-12-15 出版日期:2018-12-15 发布日期:2018-12-15
  • 通讯作者: 李佩青 E-mail:annie_129@126.com
  • 基金资助:
    chronic granulomatosis; CYBB gene; spontaneous mutation; newborn

Clinical and genetic analysis of neonatal chronic granulomatosis in one case

 SHEN Jun, XIONG Yumei, PENG Qiuyan, LIU Guangming, GONG Yun, WU Jinxia, YANG Haomei, LU Jiaming, LI Peiqing   

  1. Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong, China
  • Received:2018-12-15 Online:2018-12-15 Published:2018-12-15

摘要: 目的 了解新生儿慢性肉芽肿病(CGD)的临床特征和诊断。方法 回顾分析1例新生儿CGD的临床资料。 结果 患儿系新生儿期起病,除反复发热外,临床症状及体征不明显,接种疫苗后出现皮疹,曾有小脓疱性皮疹;中性粒 细胞呼吸爆发功能检测提示刺激指数(SI)明显下降,曲霉菌抗原阳性,结核抗体、PPD实验及T-SPOT均阴性,肺部CT影 像学可见多处结节实变影。抗感染及对症治疗效果不佳,后期出现巨噬细胞活化表现,自动出院后不久死亡。CYBB基因分 析发现1个半合子突变:c.845_855del(缺失),导致氨基酸改变p.E283Afs*61(移码突变)。 该变异不属于多态性位点,在 人群中发生频率极低,为自发突变。结论 对于新生儿期起病,存在疫苗接种后反应或皮肤感染、反复发热、中性粒细胞呼 吸爆发功能检测SI下降、肺部CT影像学特征性多发结节实变影者,要高度怀疑CGD,CYBB基因突变是其常见致病原因。

Abstract:  Objective To explore the clinical features and diagnosis of neonatal chronic granulomatous disease (CGD). Method The clinical data of CGD in a newborn was retrospectively analyzed. Results The onset of the disease was in the neonatal period. In addition to the repeated fever, clinical symptoms and positive signs were not obvious. However, there was a history of small pustular rash after vaccination. Respiratory burst function test of neutrophils showed that the stimulation index (SI) was significantly decreased, the aspergillus antigen was positive, and the tuberculosis antibody, PPD test and T-SPOT were all negative. Multiple nodules were visible in CT images of the lung. Anti-infective and symptomatic treatments were not effective, and macrophage activation appeared in the later stage, and the patient died soon after discharge. CYBB gene analysis revealed a hemizygous mutation, c.845_855del (deletion), resulting in amino acid changes of p.E283Afs*61 (frameshift mutation). The mutation is a spontaneous mutation, which does not belong to polymorphisms and happens with very low frequency in the population. Conclusion CGD should be highly suspected in patients with neonatal onset, reaction or skin infection after vaccination, recurrent fever, decreased SI detected by neutrophil respiratory burst function, and multiple nodules characterized by lung CT imaging. CYBB gene mutation is the common cause of CGD.