Service de Pédiatrie, CHU de Limoges, Limoges, France.
Service de Néphrologie Pédiatrique, CHU de Toulouse, Toulouse, France.
Eur J Hum Genet. 2020 Jan;28(1):56-63. doi: 10.1038/s41431-019-0490-6. Epub 2019 Sep 3.
The prevalence of neurological involvement in patients with a deletion of or a variant in the HNF1B gene remains discussed. The aim of this study was to investigate the neuropsychological outcomes in a large cohort of children carrying either a HNF1B whole-gene deletion or a disease-associated variant, revealed by the presence of kidney anomalies. The neuropsychological development-based on school level-of 223 children included in this prospective cohort was studied. Data from 180 children were available for analysis. Patients mean age was 9.6 years, with 39.9% of girls. Among these patients, 119 carried a HNF1B deletion and 61 a disease-associated variant. In the school-aged population, 12.7 and 3.6% of patients carrying a HNF1B deletion and a disease-associated variant had special educational needs, respectively. Therefore, the presence of a HNF1B deletion increases the risk to present with a neuropsychiatric involvement when compared with the general population. On the other hand, almost 90% of patients carrying a HNF1B disease-associated variant or deletion have a normal schooling in a general educational environment. Even if these findings do not predict the risk of neuropsychiatric disease at adulthood, most patients diagnosed secondary to kidney anomalies do not show a neurological outcome severe enough to impede standard schooling at elementary school. These results should be taken into account in prenatal counseling.
神经受累在携带 HNF1B 基因缺失或变异的患者中较为常见。本研究旨在调查一组由肾脏异常引起的、携带 HNF1B 全基因缺失或疾病相关变异的儿童的神经心理学结局。该前瞻性队列纳入了 223 名儿童,对其进行基于学校水平的神经心理学发育研究。分析了 180 名儿童的数据。患者平均年龄为 9.6 岁,女孩占 39.9%。其中,119 名患者携带 HNF1B 缺失,61 名患者携带疾病相关变异。在学龄儿童中,分别有 12.7%和 3.6%的携带 HNF1B 缺失和疾病相关变异的患者有特殊教育需求。因此,与普通人群相比,携带 HNF1B 缺失会增加出现神经精神受累的风险。另一方面,携带 HNF1B 疾病相关变异或缺失的患者中,近 90%在普通教育环境中接受正常的学校教育。即使这些发现不能预测成年后神经精神疾病的风险,但大多数因肾脏异常而诊断的患者的神经学结局并没有严重到足以阻碍小学的标准教育。在产前咨询中应考虑这些结果。