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一例因核纤层蛋白A/C(LMNA)突变导致的邓尼根型家族性部分脂肪营养不良(FPLD)并发终末期肾病。

A case of Dunnigan-type familial partial lipodystrophy (FPLD) due to lamin A/C (LMNA) mutations complicated by end-stage renal disease.

作者信息

Imachi Hitomi, Murao Koji, Ohtsuka Shouji, Fujiwara Mako, Muraoka Tomie, Hosokawa Hitoshi, Ishida Toshihiko

机构信息

Department of Internal Medicine, Kagawa University, 1750-1, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

出版信息

Endocrine. 2009 Feb;35(1):18-21. doi: 10.1007/s12020-008-9127-1. Epub 2008 Nov 15.

DOI:10.1007/s12020-008-9127-1
PMID:19011997
Abstract

Dunnigan-type familial partial lipodystrophy (FPLD) is a rare monogenic adipose tissue disorder in which the affected subjects have increased predisposition to insulin resistance and related metabolic complications, such as glucose intolerance, diabetes, dyslipidemia, and hepatic steatosis. Our patient was a 35-year-old female who had been receiving insulin injection therapy for diabetes mellitus and was transferred to our hospital. She was diagnosed with FPLD on the basis of the following symptoms: increase in subcutaneous fat in the face, neck, and upper trunk; loss of subcutaneous fat in the lower limbs and the gluteal region. We found a heterozygous CGG to CAG transition in codon 482 of exon 8 in the gene encoding lamin A/C (LMNA), which leads to an arginine to glutamine substitution (R482Q). At the time of admission, her serum creatinine level was 8.4 mg/dl, and her blood urea nitrogen (BUN) level was 81 mg/dl. Her serum creatinine level was elevated and hemodialysis was performed twice every week. However, she died of cerebral hemorrhage 9 months after hemodialysis. Although it is uncommon for patients with FPLD to exhibit renal dysfunction and require hemodialysis, this case suggests the need for careful analysis of renal function in a patient with FPLD.

摘要

邓尼根型家族性部分脂肪营养不良(FPLD)是一种罕见的单基因脂肪组织疾病,患病个体更容易出现胰岛素抵抗及相关代谢并发症,如葡萄糖不耐受、糖尿病、血脂异常和肝脂肪变性。我们的患者是一名35岁女性,一直在接受糖尿病胰岛素注射治疗,后转至我院。根据以下症状,她被诊断为FPLD:面部、颈部和上半身皮下脂肪增加;下肢和臀部皮下脂肪减少。我们在编码核纤层蛋白A/C(LMNA)的基因外显子8的第482密码子处发现了一个杂合的从CGG到CAG的转变,这导致了精氨酸到谷氨酰胺的替代(R482Q)。入院时,她的血清肌酐水平为8.4mg/dl,血尿素氮(BUN)水平为81mg/dl。她的血清肌酐水平升高,每周进行两次血液透析。然而,血液透析9个月后,她死于脑出血。虽然FPLD患者出现肾功能不全并需要血液透析的情况并不常见,但该病例提示对FPLD患者需要仔细分析其肾功能。

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解读与LMNA相关脂肪营养不良的临床表现:115例报告及系统评价
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