Journal of Clinical Pediatrics >
Clinical features of fructose-1,6-bisphosphatase deficiency in 4 children and literature review
Received date: 2025-11-03
Accepted date: 2026-01-23
Online published: 2026-05-08
Objective To summarize the clinical features and genetic variation characteristics of children with fructose-1,6-bisphosphatase deficiency (FBP1D) caused by FBP1 gene variations. Methods Four pediatric patients with FBP1D admitted from January 2019 to June 2025 were enrolled as study subjects. Their clinical manifestations, laboratory findings, genetic testing results, treatment strategies, and prognosis were analyzed retrospectively. Additionally, a literature review was conducted to summarize data of previously reported Chinese FBP1D patients. Results The four patients were from four unrelated families, including 1 male and 3 females, with ages at diagnosis of 2 years and 3 months, 3 years and 5 months, 2 years and 11 months, and 4 years and 4 months, respectively. Core clinical presentations included fever, vomiting, anorexia, accompanied by drowsiness, fatigue, hyperhidrosis, and lethargy. Laboratory tests revealed hypoglycemia, metabolic acidosis, elevated lactate, and increased blood ketone bodies. All patients carried homozygous or compound heterozygous FBP1 gene variants, among which three novel variants were identified (c.242T>C, c.469G>C, c.115C>A). During a follow-up period of 6 months to 6 years, all patients achieved well-controlled disease under strict dietary management and close blood glucose monitoring, with essentially normal physical and mental development. As of December 20, 2025, a total of 38 FBP1D cases had been reported in China (23 males, 15 females), with the most common manifestations being hypoglycemia, metabolic acidosis, and convulsions. Approximately 81.6% of patients exhibited normal intellectual and motor development without neurological sequelae. The most frequent FBP1 gene variants were c.960dup, c.960del, c.490G>A, c.704del, and c.355G>A. Conclusion Ketotic hypoglycemia accompanied by metabolic acidosis and elevated lactate should raise suspicion of FBP1D, and genetic testing is recommended in such cases. Rational dietary management and blood glucose monitoring can effectively reduce the frequency of hypoglycemic episodes in FBP1D children. Hypoglycemic attacks tend to decrease with age, and most patients have a favorable prognosis.
Key words： ketotic hypoglycemia; FBP1 gene; fructose-1; 6-bisphosphatase deficiency; child
HUANG Shuyue , CHENG Ming , WANG Xi′ou , SONG Yi , DU Mu , SONG Fuying , CAO Bingyan . Clinical features of fructose-1,6-bisphosphatase deficiency in 4 children and literature review[J]. Journal of Clinical Pediatrics, 2026 , 44(5) : 438 -444 . DOI: 10.12372/jcp.2026.25e1355
| [1] | Baker L, Winegrad AI. Fasting hypoglycemia and metabolic acidosis associated with deficiency of hepatic fructose-1,6-bisphosphatase activity[J]. Lancet, 1970, 2: 13-16. |
| [2] | Bijarnia-Mahay S, Bhatia S, Arora V. Fructose-1,6-bisphosphatase deficiency[EB/OL]. Seattle (WA): University of Washington, 1993-2025. https://www.ncbi.nlm.nih.gov/books/. |
| [3] | Piziak VK, Cryar AK. Hypoglycemic disorders[J]. N Engl J Med, 1995, 332(17): 1154. |
| [4] | Metwalley KA, Farghaly HS. Idiopathic ketotic hypoglycemia in children: an update[J]. Ann Pediatr Endocrinol Metab, 2024, 29(3): 152-155. |
| [5] | Li N, Chang G, Xu Y, et al. Clinical and molecular characterization of patients with fructose-1,6-bisphosphatase deficiency[J]. Int J Mol Sci, 2017, 18(4): 857. |
| [6] | 刘颖文, 闫露露, 张玉鑫, 等. FBP1基因变异致果糖-1, 6-二磷酸酶缺乏症患儿1例的临床及遗传学分析并文献复习[J]. 中华医学遗传学杂志, 2025, 42(6): 719-728. |
| Liu YW, Yan LL, Zhang YX, et al. Clinical and genetic analysis of a child with fructose-1,6-bisphosphatase deficiency caused by FBP1 gene variation and literature review[J]. Zhonghua Yixue Yichuanxue Zazhi, 2025, 42(6): 719-728. | |
| [7] | 王华, 薛峰, 熊复, 等. 果糖-1,6-二磷酸酶缺乏症基因型-表型相关性研究: 一例报告及文献复习[J]. 国际生殖健康/计划生育杂志, 2025, 44(5): 377-382. |
| Wang H, Xue F, Xiong F, et al. Genotype-phenotype correlation study of fructose-1,6-bisphosphatase deficiency: a case report and literature review[J]. Guoji Shengzhi Jiankang/Jihua Shengyu Zazhi, 2025, 44(5): 377-382.. | |
| [8] | 张赟健, 路通, 王艺. FBP1基因突变致果糖-1,6-二磷酸酶缺乏的癫痫持续状态1例并文献复习[J]. 中国循证儿科杂志, 2018, 13(3): 219-223. |
| Zhang YJ, Lu T, Wang Y. Status epilepticus caused by FBP1 gene mutation in fructose-1,6-bisphosphatase deficiency: a case report and literature review[J]. Zhongguo Xunzheng Erke Zazhi, 2018, 13(3): 219-223. | |
| [9] | 杨蒙洁, 卢一丽, 吴慧平, 等. 一例延迟诊断7年的果糖-1,6-二磷酸酶缺乏症报道及文献复习[J]. 中华内分泌代谢杂志, 2021, 37(5): 457-461. |
| Yang MJ, Lu YL, Wu HP, et al. A case report of fructose-1,6-bisphosphatase deficiency with delayed diagnosis for 7 years and literature review[J]. Zhonghua Neifenmi Daixie Zazhi, 2021, 37(5): 457-461. | |
| [10] | Do?ruel H, Aydemir M, Y?lmaz N, et al. An extremely rare case of hypoglycemia with a novel mutation and review of the literature: fructose1,6 bisphosphatase deficiency in an adult man[J]. Ir J Med Sci, 2024, 193(3): 1267-1273. |
| [11] | Visser G, Bakker H, Klerk JD, et al. Natural history and treatment of fructose-1,6, bisphosphatase deficiency in the Netherlands[J]. J Inherit Metab Dis, 2004, 27(1 Suppl): 207. |
| [12] | Lebigot E, Brassier A, Zater M. et al. Fructose-1,6-bisphosphatase deficiency: clinical, biochemical and genetic features in French patients[J]. J Inherit Metab Dis, 2015, 38(5): 881-887. |
| [13] | Pinheiro FC, Sperb-Ludwig F, Ligabue-Braun R. et al. Genetic analysis of patients with fructose-1,6- bisphosphatase deficiency[J]. Gene, 2019, 699: 102-109. |
| [14] | Ni Q, Tang M, Chen X. et al. Fructose-1,6- bisphosphatase deficiency: estimation of prevalence in the Chinese population and analysis of genotype-phenotype association[J]. Front. Genet, 2024, 15:1296797. |
| [15] | Emecen Sanli M, Cengiz B, et al. Fructose 1,6 bisphosphatase deficiency: outcomes of patients in a single center in Turkey and identification of novel splice site and indel mutations in FBP1[J]. J Pediatr Endocrinol Metab, 2022, 35(4): 497-503. |
| [16] | K?l?? M, Kasapkara ?S, Y?lmaz DY. Exon 2 deletion represents a common mutation in Turkish patients with fructose-1,6-bisphosphatase deficiency[J]. Metab Brain Dis, 2019, 34: 1487-1491. |
| [17] | Santer R, du Moulin M, Shahinyan T, et al. A summary of molecular genetic findings in fructose-1,6-bisphosphatase deficiency with a focus on a common long-range deletion and the role of MLPA analysis[J]. Orphanet J Rare Dis, 2016, 11: 44. |
| [18] | Bhai P, Bijarnia-Mahay S, Puri RD, et al. Clinical and molecular characterization of Indian patients with fructose-1, 6- bisphosphatase deficiency: identification of a frequent variant (E281K)[J]. Ann Hum Genet, 2018, 82(5): 309-317. |
| [19] | Yasir Zahoor M, Cheema HA, Ijaz S, et al. Genetic analysis of tyrosinemia type 1 and fructose-1, 6 bisphosphatase deficiency affected in Pakistani cohorts[J]. Fetal Pediatr Pathol, 2020, 39(5): 430-440. |
| [20] | Ijaz S, Zahoor MY, Imran M, et al. Genetic analysis of fructose-1,6-bisphosphatase (FBPase) deficiency in nine consanguineous Pakistani families[J]. J Pediatr Endocrinol Metab 2017, 30: 1203-1210. |
| [21] | Matsuura T, Chinen Y, Arashiro R, et al. Two newly identified genomic mutations in a Japanese female patient with fructose-1, 6-bisphosphatase (FBPase) deficiency[J]. Mol Genet Metab, 2002, 76: 207e10. |
| [22] | Salih RM, Mohammed EA, Alhashem AM, et al. Fructose-1,6-bisphosphatase deficiency with confirmed molecular diagnosis. An important cause of hypoglycemia in children[J]. Saudi Med J, 2020, 41(2): 199-202 |
| [23] | 王霞, 邱文娟. 糖原累积病I型研究进展[J]. 国际儿科学杂志, 2008, 35(5): 436-438. |
| Wang X, Qiu WJ. Research progress of glycogen storage disease type I[J]. Guoji Erkexue Zazhi, 2008, 35(5): 436-438. | |
| [24] | el-Maghrabi MR, Lange AJ, Jiang W, et al. Human fructose-1,6-bisphosphatase gene (FBP1): exonintron organization, localization to chromosome bands 9q22.2q22.3, and mutation screening in subjects with fructose-1,6-bisphosphatase deficiency[J]. Genomics, 1995, 27: 520-525. |
| [25] | 喻菱, 陈晓红. 1例FBP1基因突变导致的果糖-1,6-二磷酸酶缺乏症的临床及遗传学分析[J] .标记免疫分析与临床, 2025, 32(5): 1089-1097. |
| Yu L, Chen XH. Clinical and genetic analysis of a case with fructose-1,6-bisphosphatase deficiency caused by FBP1 gene mutation[J]. Biaoji Mianyi Fenxi Yu Linchuang, 2025, 32(5): 1089-1097. | |
| [26] | 寇睿, 陈志红. 果糖-1,6-二磷酸酶缺乏症诊疗进展[J]. 国际儿科杂志, 2019, 44(8): 535-538. |
| Kou R, Chen ZH. Advances in diagnosis and treatment of fructose-1,6-bisphosphatase deficiency[J]. Guoji Erke Zazhi, 2019, 44(8): 535-538. | |
| [27] | 程燕丽, 王丽, 韩乐, 等. 先天性果糖代谢缺陷病的研究进展[J]. 生理科学进展, 2020, 51(6): 469-474. |
| Cheng YL, Wang L, Han L, et al. Research progress of congenital fructose metabolism defects[J]. Shengli Kexue Jinzhan, 2020, 51(6): 469-474. | |
| [28] | Pinto A, Alfadhel M, Akroyd R, et al. International practices in the dietary management of fructose 1-6 biphosphatase deficiency[J]. Orphanet J Rare Dis, 2018, 25, 13(1): 21. |
| [29] | Ferguson C, Madison A, Hamosh A, et al. Metabolic management of a successful pregnancy and postpartum complications in fructose-1,6-bisphosphatase deficiency[J]. JIMD Rep, 2024, 65(6): 401-405 |
| [30] | Gorce M, Lebigot E, Arion A, et al. Fructose-1,6-bisphosphatase deficiency causes fatty liver disease and requires long-term hepatic follow-up[J]. J Inherit Metab Dis, 2022, 45(2): 215-222. |
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