Thakar Monica S, Hintermeyer Mary K, Gries Miranda G, Routes John M, Verbsky James W
Department of Pediatrics, Divisions of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, United States.
Children's Hospital of Wisconsin, Milwaukee, WI, United States.
Front Immunol. 2017 Nov 8;8:1470. doi: 10.3389/fimmu.2017.01470. eCollection 2017.
Severe combined immunodeficiency (SCID) is a life-threatening condition of newborns and infants caused by defects in genes involved in T cell development. Newborn screening (NBS) for SCID using the T cell receptor excision circle (TREC) assay began in Wisconsin in 2008 and has been adopted or is being implemented by all states in 2017. It has been established that NBS using the TREC assay is extremely sensitive to detect SCID in the newborn period. Some controversies remain regarding how screening positives are handled by individual states, including when to perform confirmatory flow cytometry, what is the necessary diagnostic workup of patients, what infection prophylaxis measures should be taken, and when hematopoietic stem cell transplantation should occur. In addition, the TREC can also assay detect infants with T cell lymphopenia who are not severe enough to be considered SCID; management of these infants is also evolving.
重症联合免疫缺陷(SCID)是一种危及新生儿和婴儿生命的疾病,由参与T细胞发育的基因缺陷引起。2008年,威斯康星州开始使用T细胞受体切除环(TREC)检测法对SCID进行新生儿筛查(NBS),到2017年所有州都已采用或正在实施该检测法。已证实,使用TREC检测法进行的NBS在新生儿期检测SCID时极其敏感。关于各个州如何处理筛查阳性结果仍存在一些争议,包括何时进行确认性流式细胞术、患者所需的诊断检查是什么、应采取哪些感染预防措施以及何时应进行造血干细胞移植。此外,TREC检测法还可以检测出T细胞淋巴细胞减少但病情严重程度不足以被视为SCID的婴儿;对这些婴儿的管理也在不断发展。