Sun Jin-qiao, Wang Lai-shuan, Qi Chun-hua, Ying Wen-jing, Guo Xiao-hong, Liu Dan-ru, Hui Xiao-ying, Liu Fang, Cao Yun, Luo Fei-hong, Wang Xiao-chuan
Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai 201102, China.
Zhonghua Er Ke Za Zhi. 2012 Dec;50(12):944-7.
To investigate the clinical features and molecular diagnostic methods of three patients with DiGeorge anomaly.
The clinical manifestations and immunological features of the three cases with DiGeorge anomaly were analyzed. We detected the chromosome 22q11.2 gene deletion by fluorescence in situ hybridization (FISH).
(1) CLINICAL MANIFESTATIONS: All three cases had varying degrees of infection, congenital heart disease and small thymus by imaging; two cases had significant hypocalcemia (1.11 mmol/L and 1.22 mmol/L, respectively), accompanied by convulsions; only 1 case had cleft palate and all had no significant facial deformity. (2) Immunological characteristics: All three cases had varying degrees of T-cell immune function defects (percentage of T lymphocytes was 24% - 43%, absolute count was 309 - 803/µl), and levels of immunoglobulin G, A, M, and percent of B lymphocytes and absolute count were normal. (3) Detection of the chromosome 22q11.2 gene deletion: 400 cells of each case were detected. All cells showed two green and one red hybridization signal, indicating the presence of gene deletions in chromosome 22q11.2. (4) OUTCOME: All three cases were treated with thymosin, and appropriate clinical intervention for cardiac malformations, hypocalcemia, and were followed-up for 4 - 18 months, the prognosis was good.
DiGeorge anomaly showed diverse clinical manifestations. We should consider the disease if patients had congenital heart disease, thymic hypoplasia, hypocalcemia and/or impaired immune function. FISH for detecting chromosome 22q11.2 gene deletion can be used as accurate and rapid diagnostic method. Thymosin treatment and other clinical intervention may help to improve the prognosis of patients with partial DiGeorge anomaly.
探讨3例22q11.2微缺失综合征患者的临床特征及分子诊断方法。
分析3例22q11.2微缺失综合征患者的临床表现及免疫学特征。采用荧光原位杂交(FISH)技术检测22号染色体长臂1区2带(22q11.2)基因缺失情况。
(1)临床表现:3例患者影像学检查均显示有不同程度的感染、先天性心脏病及胸腺发育不良;2例患者有明显低钙血症(分别为1.11 mmol/L和1.22 mmol/L),并伴有惊厥;仅1例患者有腭裂,所有患者均无明显面部畸形。(2)免疫学特征:3例患者均有不同程度的T细胞免疫功能缺陷(T淋巴细胞百分比为24% - 43%,绝对计数为309 - 803/µl),免疫球蛋白G、A、M水平及B淋巴细胞百分比和绝对计数均正常。(3)22q11.2基因缺失检测:每例检测400个细胞,所有细胞均显示两个绿色和一个红色杂交信号,提示22q11.2染色体存在基因缺失。(4)转归:3例患者均给予胸腺素治疗,并对心脏畸形、低钙血症进行了适当的临床干预,随访4 - 18个月,预后良好。
22q11.2微缺失综合征临床表现多样,对于有先天性心脏病、胸腺发育不良、低钙血症和(或)免疫功能受损的患者应考虑本病。FISH检测22q11.2基因缺失可作为准确、快速的诊断方法。胸腺素治疗及其他临床干预可能有助于改善部分22q11.2微缺失综合征患者的预后。