临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (12): 936-.doi: 10.3969/j.issn.1000-3606.2020.12.013

• 综合报道 • 上一篇    下一篇

先天性胆汁酸合成障碍2型8例临床特征及基因变异分析

佘兰辉, 李旭芳, 叶家卫, 谭丽梅, 杨花梅, 房春晓, 龚余, 徐翼   

  1. 广东省广州市妇女儿童医疗中心(广东广州 510120)
  • 出版日期:2020-12-15 发布日期:2020-12-18
  • 通讯作者: 徐翼 电子信箱:xuyi70@163.com

Clinical features and gene variation of congenital bile acid synthesis disorder type 2 in 8 children

SHE Lanhui, LI Xufang, YE Jiawei, TAN Limei, YANG Huamei, FANG Chunxiao, GONG Yu, XU Yi   

  1. Guangzhou Women and Children's Medical Center, Guangzhou 510120 , Guangdong, China
  • Online:2020-12-15 Published:2020-12-18

摘要: 目的 分析先天性胆汁酸合成障碍2型的临床及基因变异特征。方法 回顾分析8例先天性胆汁酸合成障碍 2型患儿的临床资料。结果 8例患儿中,男性6例、女性2例,于出生6 ~12周因黄疸就诊,中位诊断年龄4.7个月。6例患 儿排浅黄色大便,均为胆汁淤积性肝病,胆汁酸无异常。6例患儿γ-GT无异常,3例患儿有凝血障碍,5例患儿有血氨基酸 谱改变。彩色超声示胆囊充盈差或不充盈。8例患儿均发现AKR 1 D 1基因变异。4例为AKR 1 D 1纯合变异,3例复合杂合变 异,1例单杂合变异,结合尿类固醇分析明确诊断。结论 先天性胆汁酸合成障碍2型患儿在婴儿早期即可出现胆汁淤积, γ-GT及胆汁酸无明显异常,部分可出现凝血功能障碍。基因和尿类固醇检测可明确诊断。

关键词:  胆汁酸合成障碍; 基因; 黄疸

Abstract: Objective To explore the clinical features and characteristics of genetic variation in congenital bile acid synthesis disorder type 2. Method The clinical data of congenital bile acid synthesis disorder type 2 in 8 children was retrospectively analyzed. Results Eight children ( 6 boys and 2 girls) had clinic visit for jaundice between 6 and 12 weeks after birth, and the median diagnosis age was 4 . 7 months. Six children had pale yellow stools, and all had cholestatic hepatitis with normal bile acid. There was normalγ-GT in 6 cases, coagulation disorder in 3 cases and amino acid changes in 5 cases. Color Doppler ultrasonography showed poor or no filling of gallbladder. AKR 1 D 1 gene mutation was found in all 8 cases. Four cases were AKR1D 1 homozygous variants, 3 cases were compound heterozygous variants, and one case was single-heterozygous variants. In combination with urine steroid analysis, the diagnosis was confirmed. Conclusions Cholestasis can be found in children with congenital bile acid synthesis disorder type 2 in early infancy. There is no obvious abnormality in γ - GT and bile acid, and coagulation dysfunction can be found in some cases. Gene and urine steroid detection can confirm the diagnosis.

Key words: bile acid synthesis disorders; gene; jaundice