临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (10): 976-.doi: 10.3969 j.issn.1000-3606.2014.10.020

• 罕见病 疑难病
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早发型球形细胞脑白质营养不良的临床及基因分析1 例报告

张尧,丁圆,李溪远,王峤,宋金青,刘玉鹏,杨艳玲   

  1. 北京大学第一医院儿科( 北京 100034)
  • 收稿日期:2014-10-15 出版日期:2014-10-15 发布日期:2014-10-15
  • 通讯作者: 杨艳玲 E-mail:organic.acid@126.com
  • 基金资助:
    “十二五”国家科技支撑计划项目资助(No.2012BAI09B04)

The clinical and genetic features of early-onset globoid cell leukodystrophy in one boy

Zhang Yao, Ding Yuan, Li Xiyuan, Wang Qiao, Song Jinqing, Liu Yupeng, Yang Yanling   

  1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
  • Received:2014-10-15 Online:2014-10-15 Published:2014-10-15

摘要: 目的 探讨球形细胞脑白质营养不良的临床及基因诊断。方法 回顾性分析1例罕见的早发婴儿型球形细胞脑白质营养不良的临床及基因分析资料。结果 患儿,男,于生后2个月进行性精神运动倒退;4个月就诊,锥体束征阳性;头颅MRI示双侧脑室体部略大,额颞顶叶脑沟裂宽深;头颅CT示双基底节区、丘脑、小脑半球稍高信号;外周血白细胞β-半乳糖苷酶活性降低为3.9 nmol/(g protein·h);基因分析证实,GALC外显子8存在纯合的c.868C>T突变,为一新的错义突变,导致氨基酸改变p.R290C。结论 早发型球形细胞脑白质营养不良是一种致死性常染色体隐性遗传性溶酶体贮积症,是由于GALC基因缺陷导致的β-半乳糖苷酶缺乏症;临床诊断困难,确诊需依靠酶学及基因分析。

Abstract: Objective To investigate the clinical, biochemical and genetic features of a Chinese boy with early-onset globoid cell leukodystrophy (GLD). Methods The clinical and genetic data of a rare case of early-onset GLD were retrospectively analysed. Results At 2 months after birth, the boy showed progressive psychomotor regression. At 4 months of age when the boy was taken to a doctor, the pyramidal sign was positive. The cranial MRI showed that the body of the lateral cerebral ventricles was slightly enlarged and the brain ditch crack of frontal-temporal-parietal lobe was widened and deepened. On his brain CT scan, high signals in bilateral basal ganglia, thalami, cerebellar hemisphere were observed. β-galactosylceramidase (GALC) activity in the peripheral leucocytes was significantly decreased (3.9 nmol/g protein.h). On his GALC gene, one homozygous novel mutation c.868C>T on exon 8 was found, which resulted in the amino acid change on p.R290C proteins. Conclutions Early-onset GLD is a rare autosomal-recessive hereditary lysosomal storage disease with a terrible prognosis, in which beta-galactose glucoside enzyme deficiency is induced by GALC gene mutation. The diagnosis of early-onset GLD is difficult and should depend on enzyme assay and gene testing.