Belousova E D, Dorofeeva M Yu, Pivovarova A M, Katusheva O V
GBOU VPO 'Rossijskij natsional'nyj issledovatel'skij meditsinskij universitet im. N.N. Pirogova', Moskva, Nauchno-klinicheskij institut pediatrii, Moskva.
Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(10):89-95. doi: 10.17116/jnevro201511510189-95.
Tuberous sclerosis complex is a autosomal dominant instantly progressing disease, causing the development of benign tumors in all organs and tissues of human body. According to International Consensus Conference (2012), definite or possible TSC diagnosis can be made. For the definite diagnosis of TSC, two major criteria or one major criterion and ≥2 minor criteria have to be present. For a possible diagnosis, 1 major criterion or ≥2 minor criteria should be found. A pathogenic mutation in the TSC1 or TSC2 gene is by itself sufficient for a definite diagnosis. There are following major diagnostic criteria: angiofibromas (≥3) or forehead plaque; hypomelanotic macules (≥3); ungual fibromas (≥2); chagrin patch; multiple retinal hamartomas; cortical dysplasias (≥3, include tubers and cerebral white matter radial migration lines; subependymal nodules; subependymal giant cell astrocytoma; cardiac rhabdomyoma; lymphagioleiomatosis and renal angiomyolipomas (≥2). The minor criteria are the following ones: dental enamel pits (≥3); intraoral fibromas (≥2); non-renal hamartomas; retinal achromatic patch; confetti skin lesions; multiple renal cysts. Diagnosis of TSC is not difficult if a physician is familiar with clinical presentation of the disease.
结节性硬化症是一种常染色体显性的进行性疾病,可导致人体所有器官和组织中出现良性肿瘤。根据国际共识会议(2012年),可做出明确或可能的结节性硬化症诊断。对于结节性硬化症的明确诊断,必须具备两条主要标准或一条主要标准及≥2条次要标准。对于可能的诊断,应发现1条主要标准或≥2条次要标准。TSC1或TSC2基因中的致病性突变本身就足以做出明确诊断。主要诊断标准如下:血管纤维瘤(≥3个)或前额斑块;色素减退斑(≥3个);甲周纤维瘤(≥2个);鲨革斑;多发性视网膜错构瘤;皮质发育异常(≥3个,包括结节和脑白质放射状移行线);室管膜下结节;室管膜下巨细胞星形细胞瘤;心脏横纹肌瘤;淋巴管平滑肌瘤病和肾血管平滑肌脂肪瘤(≥2个)。次要标准如下:牙釉质坑(≥3个);口腔内纤维瘤(≥2个);非肾错构瘤;视网膜无色斑;五彩纸屑样皮肤病变;多发性肾囊肿。如果医生熟悉该疾病的临床表现,结节性硬化症的诊断并不困难。