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先天性纯红细胞再生障碍性贫血:遗传学、发病机制、诊断与治疗

Diamond Blackfan Anemia: Genetics, Pathogenesis, Diagnosis and Treatment.

作者信息

Engidaye Getabalew, Melku Mulugeta, Enawgaw Bamlaku

机构信息

Amhara Regional State Debre Berhan Health Science College, Debre Berhan, Ethiopia.

Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Ethiopia.

出版信息

EJIFCC. 2019 Mar 1;30(1):67-81. eCollection 2019 Mar.

Abstract

Diamond Blackfan Anaemia (DBA) is a sporadic inherited anemia with broad spectrum of anomalies that are presented soon after delivery. It is inherited mainly in autosomal dominant inheritance manner and caused by mutations and deletions in either large or small ribosomal protein genes that results in an imbalance between the biosynthesis of rRNA and ribosomal proteins, eventually the activation and stabilization of p53. Diagnosing DBA is usually problematic due to a partial phenotype and its wide inconsistency in its clinical expression; however, molecular studies have identified a heterozygous mutated gene in up to 50% of the DBA cases and corticosteroid drugs are the backbone treatment options of DBA. Anomalies in bone marrow function in DBA cases are broadly associated with both congenital and acquired bone marrow failure syndromes in human. In this review different literatures were searched in Medline (eg. PubMed, PMC, Hinari, Google scholar), OMIM, EMBASE by using search engines (Google, Yahoo, Baidu Ask.com) and searching was performed by using search key words (DBA, ribosomopathies, Bone Marrow Failure Syndromes, pure red cell aplasia). Only human studies were included. This review is summarizing the current understandings of DBA.

摘要

先天性纯红细胞再生障碍性贫血(DBA)是一种散发性遗传性贫血,伴有多种出生后不久即出现的异常情况。它主要以常染色体显性遗传方式遗传,由大小核糖体蛋白基因的突变和缺失引起,导致核糖体RNA(rRNA)与核糖体蛋白的生物合成失衡,最终激活并稳定p53。由于部分表型及其临床表达存在广泛的不一致性,DBA的诊断通常存在问题;然而,分子研究已在高达50%的DBA病例中鉴定出杂合突变基因,皮质类固醇药物是DBA的主要治疗选择。DBA病例中的骨髓功能异常与人类先天性和后天性骨髓衰竭综合征广泛相关。在本综述中,通过使用搜索引擎(谷歌、雅虎、百度知道)在医学在线数据库(如PubMed、PMC、Hinari、谷歌学术)、在线人类孟德尔遗传数据库(OMIM)、荷兰医学文摘数据库(EMBASE)中检索了不同文献,并使用搜索关键词(DBA、核糖体病、骨髓衰竭综合征、纯红细胞再生障碍)进行搜索。仅纳入了人体研究。本综述总结了目前对DBA的认识。

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