临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (11): 848-.doi: 10.3969/j.issn.1000-3606.2018.11.011

• 综合报道 • 上一篇    下一篇

ELANE 基因突变致先天性粒细胞减少症 1 例临床及基因分析#br#

何庭艳 1, 杨军 1, 王晓东 2, 夏宇 1, 张小玲 2, 王春静 2, 李成荣 1, 刘四喜 2   

  1. 深圳市儿童医院 1.风湿免疫科,2.血液肿瘤科(广东深圳 518038)
  • 收稿日期:2018-11-15 出版日期:2018-11-15 发布日期:2018-11-15
  • 基金资助:
    深圳市科技创新项目(No.JCY2017303155201082);深圳市三名工程项目(No.SZSM20182002)

Clinical and genetic analysis of a patient with congenital neutropenia caused by ELANE gene mutation

HE Tingyan1, YANG Jun1, WANG Xiaodong2, XIA Yu1, ZHANG Xiaoling2, WANG Chunjing2, LI Chengrong1, LIU Sixi2   

  1. 1.Department of Rheumotology and Immunology, 2. Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China
  • Received:2018-11-15 Online:2018-11-15 Published:2018-11-15

摘要: 目的 探讨ELANE基因突变所致先天性粒细胞减少症的临床特征、基因诊断、治疗及预后。方法 分析1例 先天性粒细胞减少症患儿的临床表现、免疫学指标、基因变异特点及诊治经过。结果 患儿,女, 7个月,生后粒细胞减少 伴反复感染6个月; 1月龄时患支气管肺炎、中耳炎, 2月龄时患化脓性颈部淋巴结炎、脐部化脓性感染、自身免疫性溶血 性贫血,疑诊幼年型粒单核细胞白血病。体格检查发现,肝脏肋下4 cm,脾脏肋下1 cm,质韧,余未见异常。中性粒细胞 (0.10~1.38)× 109/L、单核细胞(1.70~3.58)× 109/L、血红蛋白(65~108)g/L;多种病原学检测阳性;直接抗人球蛋白 实验++++;IgG 24.28 g/L;淋巴细胞分型提示B细胞数量增多。骨髓涂片示原粒细胞占7%,中性中幼粒细胞以下阶段罕 见,幼稚单核细胞占4.5%。基因测序显示ELANE基因3号外显子c.278_289del、p.93_97del自发突变。结论 ELANE基 因突变致先天性粒细胞减少症临床特征包括难治性反复细菌感染和中性粒细胞减少,可伴自身免疫现象。

Abstract: Objective To investigate clinical features, genetic diagnosis, management and prognosis of congenital neutropenia caused by ELANE gene mutation. Methods Clinical manifestations, immunological data, gene mutation, processes of diagnosis and treatment of a patient with congenital neutropenia caused by ELANE gene mutation were retrospectively analyzed. Results A 7-month old girl, suffered from neutropenia and recurrent infection for 6 months, presented with bronchial pneumonia and otitis media at 1 month old with suppurative cervical lymphadenitis, umbilical purulent infection, autoimmune hemolytic anemia and suspected juvenile myelomonocytic leukemia. When she was 2 months old, it progressed with obvious hepatomegaly and a slight enlargement of spleen, which lead to persistent neutropenia (0.1×109/L ~1.38×109/L), monocytosis (1.7×109/L ~3.58×109/L) and low hemoglobin levels (65 ~ 108 g/L). Multiple etiological culture tests were positive. Direct antihuman globulin test was strongly positive. Other abnormal immunological screens showed elevated levels of IgG (24.28 g/L), and increased B lymphocytes. Bone marrow smears showed myeloblasts (7%) and promonocyte (4.5%) without any neutral medium promyelocyte, neutral late promyelocyte or neutrophils. A heterozygous c.278_289del (p.93_97del) mutation of ELANE gene was identified by gene sequencing. Conclusions The main clinical features of congenital neutropenia caused by ELANE gene mutation include refractory recurrent bacterial infections, and neutropenia possiblely accompanied by autoimmunity.