Gilger J W
University of Arkansas for Medical Sciences, North Little Rock 72114-1706.
Clin Commun Disord. 1992 Fall;2(4):35-47.
As is typical in science, early work in an area is bound to have weaknesses. Therefore, it is not unexpected that the extent to which conclusions can be drawn from the current research on the genetics of DLD is limited. These limitations stem from the use of heterogeneous samples, the use of overly broad phenotypes, survey rather than objective test data, and only a few studies looking beyond simple familiarity. Future research is in progress that attempts to correct for these weaknesses. Still, some practically useful information can be gleaned from the work done thus far. First, we can now hypothesize something about the pathway from gene to DLD phenotype. Much of DLD, like RD, may be a manifestation of early genetic effects on the structural development of the brain (e.g., Plante, Swisher, and Vance, 1991; Plante, 1991; Molfese and Betz, 1988). However, consequences of these genetic effects for language development can still be modified by environmental events (e.g., treatment). Furthermore, genetic effects do not act in isolation and they are not necessarily static. A number of genetic and non-genetic events in the course of development may positively or negatively modify the disorder (e.g., Tomblin, 1989, Tallal et al., 1991; Molfese and Holcomb, 1989). A related point is that there is evidence for genetic heterogeneity in DLD. That different modes of transmission have been put forth by different authors, suggests that a variety of genetic forms of DLD may exist. This idea is further supported by noting that DLD is a common outcome of a number of clinical syndromes having very different genetic bases (e.g., Williams syndrome, Down syndrome, fragile X, etc.; Siegel-Sadewitz and Shprintzen, 1982; Bellugi et al., 1991). This does not rule out the possibility that a majority of nonsyndromic DLD is due to one or a few major genes, however. Finally, there is also evidence for behavioral heterogeneity in DLD. The data suggest that the genes for DLD are variably expressed. For example, in families selected through a DLD proband, a number of different language-related problems have been noted. Furthermore, when a globally defined DLD individual is examined closely, it is common to find a collection of symptoms, sometimes spanning all the major domains of language (Weiss and Lillywhite, 1981). Overall, the data and concepts presented in this article suggest that the clinician should take careful family histories of clients and, when doing so, attempt to ascertain the specific symptoms that family members other than the client exhibit.(ABSTRACT TRUNCATED AT 400 WORDS)
正如科学领域的常见情况那样,一个领域的早期研究必然存在不足。因此,从目前关于发育性语言障碍(DLD)遗传学的研究中能够得出结论的程度有限也就不足为奇了。这些局限性源于使用了异质性样本、采用了过于宽泛的表型、使用的是调查数据而非客观测试数据,并且只有少数研究超越了简单的家族相似性。目前正在进行未来研究,试图纠正这些不足。尽管如此,从迄今为止所做的工作中仍可收集到一些实际有用的信息。首先,我们现在可以对从基因到DLD表型的途径进行一些推测。与阅读障碍(RD)一样,许多DLD可能是早期基因对大脑结构发育产生影响的一种表现(例如,普兰特、斯威舍和万斯,1991年;普兰特,1991年;莫尔菲斯和贝茨,1988年)。然而,这些基因效应对于语言发育的影响仍可被环境因素(如治疗)改变。此外,基因效应并非孤立起作用,也不一定是固定不变的。发育过程中的一些基因和非基因事件可能会对这种障碍产生正向或负向的影响(例如,汤布林,1989年;塔拉尔等人,1991年;莫尔菲斯和霍尔科姆,1989年)。一个相关的观点是,有证据表明DLD存在基因异质性。不同作者提出了不同的遗传传递模式,这表明可能存在多种遗传形式的DLD。注意到DLD是许多具有截然不同遗传基础的临床综合征的常见结果(例如,威廉姆斯综合征、唐氏综合征、脆性X综合征等;西格尔 - 萨德维茨和施普林曾,1982年;贝鲁吉等人,1991年),这一观点得到了进一步支持。然而,这并不排除大多数非综合征性DLD是由一个或几个主要基因导致的可能性。最后,也有证据表明DLD存在行为异质性。数据表明,DLD相关基因的表达存在差异。例如,在通过DLD先证者选择的家庭中,人们注意到了许多不同的与语言相关的问题。此外,当对一个整体定义为DLD的个体进行仔细检查时,通常会发现一系列症状,有时涵盖了语言的所有主要领域(韦斯和利利怀特,1981年)。总体而言,本文所呈现的数据和概念表明,临床医生应该仔细询问患者的家族病史,并且在询问时,试图确定患者以外的家庭成员所表现出的具体症状。(摘要截选至400字)