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软骨发育不全临床实践指南。

Clinical Practice Guidelines for Achondroplasia.

作者信息

Kubota Takuo, Adachi Masanori, Kitaoka Taichi, Hasegawa Kosei, Ohata Yasuhisa, Fujiwara Makoto, Michigami Toshimi, Mochizuki Hiroshi, Ozono Keiichi

机构信息

Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.

Guidelines Development Committee for Achondroplasia.

出版信息

Clin Pediatr Endocrinol. 2020;29(1):25-42. doi: 10.1297/cpe.29.25. Epub 2020 Jan 9.

Abstract

Achondroplasia (ACH) is a skeletal dysplasia that presents with limb shortening, short stature, and characteristic facial configuration. ACH is caused by mutations of the gene, leading to constantly activated FGFR3 and activation of its downstream intracellular signaling pathway. This results in the suppression of chondrocyte differentiation and proliferation, which in turn impairs endochondral ossification and causes short-limb short stature. ACH also causes characteristic clinical symptoms, including foramen magnum narrowing, ventricular enlargement, sleep apnea, upper airway stenosis, otitis media, a narrow thorax, spinal canal stenosis, spinal kyphosis, and deformities of the lower extremities. Although outside Japan, papers on health supervision are available, they are based on reports and questionnaire survey results. Considering the scarcity of high levels of evidence and clinical guidelines for patients with ACH, clinical practical guidelines have been developed to assist both healthcare professionals and patients in making appropriate decisions in specific clinical situations. Eleven clinical questions were established and a systematic literature search was conducted using PubMed/MEDLINE. Evidence-based recommendations were developed, and the guidelines describe the recommendations related to the clinical management of ACH. We anticipate that these clinical practice guidelines for ACH will be useful for healthcare professionals and patients alike.

摘要

软骨发育不全(ACH)是一种骨骼发育异常疾病,表现为肢体缩短、身材矮小和特征性面部形态。ACH由该基因突变引起,导致成纤维细胞生长因子受体3(FGFR3)持续激活及其下游细胞内信号通路的活化。这会抑制软骨细胞的分化和增殖,进而损害软骨内骨化,导致短肢型身材矮小。ACH还会引发特征性临床症状,包括枕骨大孔狭窄、脑室扩大、睡眠呼吸暂停、上呼吸道狭窄、中耳炎、胸廓狭窄、椎管狭窄、脊柱后凸以及下肢畸形。尽管在日本以外地区有关于健康监督的文献,但这些文献基于报告和问卷调查结果。鉴于ACH患者高水平证据和临床指南的稀缺,已制定临床实践指南,以协助医疗专业人员和患者在特定临床情况下做出适当决策。确定了11个临床问题,并使用PubMed/MEDLINE进行了系统的文献检索。制定了基于证据的建议,该指南描述了与ACH临床管理相关的建议。我们预计这些ACH临床实践指南将对医疗专业人员和患者都有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8e7/6958518/032b6675b621/cpe-29-025-g001.jpg

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