论著

单中心11例先天性肾上腺皮质异常患儿的遗传学分析

  • 吴琴 ,
  • 潘海瑞 ,
  • 马盼盼 ,
  • 王玉佩 ,
  • 周秉博 ,
  • 郑雷 ,
  • 田芯瑗 ,
  • 惠玲 ,
  • 郝胜菊 ,
  • 孙波 ,
  • 张钏 ,
  • 郭金仙
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  • 1.甘肃省妇幼保健院(甘肃省中心医院) 甘肃省出生缺陷与罕见病临床医学研究中心、医学遗传中心(甘肃兰州 730050)
    2.甘肃省妇幼保健院(甘肃省中心医院) 小儿内分泌遗传代谢科(甘肃兰州 730050)
    3.甘肃省妇幼保健院(甘肃省中心医院)儿童早期发展中心(甘肃兰州 730050)

收稿日期: 2023-08-29

  网络出版日期: 2024-08-06

基金资助

甘肃省科技计划资助项目(22YF7FA094);甘肃省科技计划资助项目(No.20YF8FA093);甘肃省卫生行业计划项目(GSWSKY2022-33);兰州市科技计划项目资助(2021-1-182);甘肃省出生缺陷与罕见病临床医学研究中心项目(21JR7RA680)

Genetic analysis of 11 patients with congenital adrenal cortical abnormalities in a single center

  • Qin WU ,
  • Hairui PAN ,
  • Panpan MA ,
  • Yupei WANG ,
  • Bingbo ZHOU ,
  • Lei ZHENG ,
  • Xinyuan TIAN ,
  • Ling HUI ,
  • Shengju HAO ,
  • Bo SUN ,
  • Chuan ZHANG ,
  • Jinxian GUO
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  • 1. Center for Medical Genetics, Gansu Provincial Clinical Research Center for Birth Defects and Rare Diseases, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou 730050, Gansu, China
    2. Department of Pediatric Endocrinology and Metabolism, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou 730050, Gansu, China
    3. Department of Child Health, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou 730050, Gansu, China

Received date: 2023-08-29

  Online published: 2024-08-06

摘要

目的 探讨11个先天性肾上腺皮质异常患儿家系的遗传学特征。方法 选择2019年1月至2023年6月确诊的11个先天性肾上腺皮质异常患儿家系作为研究对象。应用全外显子组测序对先证者进行基因变异检测,Sanger测序及MLPA技术进行家系验证。结果 11个患儿家系经基因诊断。8例为因CYP21A2变异引起的21-羟化酶缺陷导致的先天性肾上腺皮质增生症,1例为CYP17A1变异引起的17-α羟化酶缺乏性先天性肾上腺皮质增生症,1例为STAR变异引起的脂质先天性肾上腺增生,1例为NR0B1变异引起的先天性肾上腺发育不全。CYP21A2基因共检测到7种不同的变异,这7种变异类型中频率最高的位点是c.518T>A,随后为c.293-13C>G与c.1069C>T。STAR检测到的c.780dupG与c.397C>T变异均为未报道的新变异,根据ACMG遗传变异分类标准与指南,c.780dupG位点评级为致病性变异(PVS1+PM2_Supporting+PP4),c.397C>T位点评级为临床意义未明(PM2_Supporting+PM3+PP3+PP4)。NR0B1检测到的c.64_c.65insGAGCGCGAAGC变异为未报道的新变异,该变异评级为可能致病性变异(PVS1+PM2_Supporting+PP4)。结论 对临床表型重叠的肾上腺皮质异常患儿,单凭症状和生化指标无法进行可靠鉴别,而早期基因精准诊断对确诊疾病、干预治疗、遗传咨询及生育指导至关重要。

本文引用格式

吴琴 , 潘海瑞 , 马盼盼 , 王玉佩 , 周秉博 , 郑雷 , 田芯瑗 , 惠玲 , 郝胜菊 , 孙波 , 张钏 , 郭金仙 . 单中心11例先天性肾上腺皮质异常患儿的遗传学分析[J]. 临床儿科杂志, 2024 , 42(8) : 691 -696 . DOI: 10.12372/jcp.2024.23e0821

Abstract

Objective To investigate the genetic characteristics of 11 families with congenital adrenal cortex abnormalities. Methods From January 2019 to June 2023, 11 families of patients with congenital adrenal cortex abnormalities diagnosed in the Medical Genetic Center of Gansu Maternity and Child Health Hospital were enrolled. Exome sequencing was used to detect genetic variants in the proband, Sanger sequencing and MLPA were used for verify the variants and their family origin. Results 11 patient families were genetically diagnosed: 8 cases were congenital adrenal hyperplasia due to 21-hydroxylase deficiency caused by CYP21A2 variants, and 1 case was congenital adrenal hyperplasia due to 17-α hydroxylase deficiency caused by CYP17A1 variation Cortical hyperplasia, one case of lipocongenital adrenal hyperplasia caused by STAR variants, and one case of congenital adrenal hypoplasia caused by NR0B1 variants. A total of 7 different variants were detected in the CYP21A2 gene. Among the 7 variants, the site with the highest frequency was c.518T>A, followed by c.293-13C>G and c.1069C>T. The c.780dupG and c.397C>T variants of STAR are novel variants that have not been reported. According to the ACMG Genetic Variation Classification Standards and Guidelines, the c.780dupG was categorized as pathogenic (PVS1+PM2_Supporting+PP4), c.397C>T was categorized as uncertain significance (PM2_Supporting+PM3+PP3+PP4). The variant c.64_c.65insGAGCGCGAAGC of NR0B1 is a novel variant that has not been reported, which is categorized as Likely pathogenic (PVS1+PM2_Supporting+PP4). Conclusion Patients with adrenal cortex anomalies with overlapping clinical phenotypes cannot be reliably identified by symptoms and biochemical markers alone, and early precise genetic diagnosis is essential for diagnosis of the disease, interventional therapy, genetic counseling, and fertility guidance.

参考文献

[1] 中华医学会儿科分会罕见病学组, 中国医师协会医学遗传医师分会, 中国妇幼保健协会出生缺陷防治与分子遗传分会, 等. 21羟化酶缺陷导致的先天性肾上腺皮质增生症的实验室诊断共识[J]. 中华医学遗传学杂志, 2023, 40(7): 769-780.
[2] 宫丽霏, 杨楠, 赵金琦, 等. 新生儿筛查先天性肾上腺皮质增生症30例患儿基因与临床随访分析[J]. 中国实用儿科杂志, 2023, 38(3): 218-223.
[3] 徐钰琪, 林彩娟, 耿国兴, 等. 391 714例新生儿先天性肾上腺皮质增生症筛查与基因检测[J]. 实用医学杂志, 2022, 38(14): 1825-1829.
[4] Richards S, Aziz N, Bale S, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology[J]. Genet Med, 2015, 17(5): 405-424.
[5] 中华医学会儿科学分会内分泌遗传代谢病学组. 先天性肾上腺皮质增生症21-羟化酶缺陷诊治共识[J]. 中华儿科杂志, 2016, 54(8): 569-576.
[6] 国家卫生健康委临床检验中心新生儿遗传代谢病筛查室间质评委员会. 新生儿先天性肾上腺皮质增生症筛查与诊断实验室检测技术专家共识[J]. 中华检验医学杂志, 2019, 42(12): 1014-1019.
[7] Claahsen-van der Grinten HL, Speiser PW, Ahmed SF, et al. Congenital adrenal hyperplasia-current insights in pathophysiology, diagnostics, and management[J]. Endocr Rev, 2022, 43(1): 91-159.
[8] Speiser PW, Arlt W, Auchus RJ, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2018, 103(11): 4043-4088.
[9] 陶慧慧, 陈曦, 谭新睿, 等. 湖南地区21-羟化酶缺乏症临床表型与基因型研究[J]. 中华实用儿科临床杂志, 2020, 35(9): 686-690.
[10] Lee HI, Kwon A, Suh JH, et al. Two cases of 17α-hydroxylase/17,20-lyase deficiency caused by the CYP17A1 mutation[J]. Ann Pediatr Endocrinol Metab, 2021, 26(1): 66-70.
[11] 刘君静, 任丽, 张卫, 等. 成年17α羟化酶缺陷症二例临床特征及诊疗分析[J]. 中国全科医学, 2021, 24(9): 1140-1143.
[12] Chormanski D, Muzio MR. 17-Hydroxylase deficiency[M]// StatPearls [2023-08-24]. Treasure Island (FL): StatPearls Publishing, 2023. https://www.ncbi.nlm.nih.gov/books/NBK546644/.
[13] 郑婉祺, 段颖, 肖冰, 等. 先天性类脂性肾上腺皮质增生症33例临床特点及StAR基因分析[J]. 中华儿科杂志, 2022, 60(10): 1066-1071.
[14] Ishii T, Tajima T, Kashimada K, et al. Clinical features of 57 patients with lipoid congenital adrenal hyperplasia: criteria for nonclassic form revisited[J]. J Clin Endocrinol Metab, 2020, 105(11): dgaa557.
[15] 李江, 朱铭强, 黄轲, 等. NR0B1基因新突变致先天性肾上腺发育不良1例[J]. 浙江医学, 2020, 42(19): 2113-2115.
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