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黏多糖贮积症的基本认识:发病率、临床特征、诊断与管理。

A basic understanding of mucopolysaccharidosis: Incidence, clinical features, diagnosis, and management.

作者信息

Zhou Jing, Lin Jing, Leung Wing Ting, Wang Ling

机构信息

Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China.

The Academy of Integrative Medicine of Fudan University, Shanghai, China.

出版信息

Intractable Rare Dis Res. 2020 Feb;9(1):1-9. doi: 10.5582/irdr.2020.01011.

Abstract

Mucopolysaccharidoses (MPS) are a group of rare lysosomal storage diseases (LSD) with multi-organic and severe symptoms. MPS occur worldwide in various forms though have relative a low incidence. The prevalent type of MPS varies among different continents, indicating that it may be associated with region and ethnic background. Undegraded glycosaminoglycans (GAGs) induced by deficiency of enzymes are the primary cause of MPS. Clinical features differ depending on the specific enzyme deficiency including coarse facial features, cognitive retardation, hepatosplenomegaly, hernias, kyphoscoliosis, corneal clouding, Symptoms of different types are usually similar especially MPS I and II, but may have distinguishable features such as severe neurological problems in MPS III and hydrops fetails in MPS VII. These clinical features contribute to diagnosis, but early and precisely diagnosis in the asymptomatic stage is imperative for better outcomes. Novel approaches including urinary and blood GAG test, enzyme assay and gene test help to diagnose MPS and to determine its subtype. Hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT) are conventional treatment for MPS, but are not effective at treating all MPS. Newer threatments, such as advanced ERT, gene therapy and substrate reduction therapy (SRT), improve therpeutic efficacy. In this review, we update information on the clinical manifestations, diagnosis, and treatment of the different forms of this disease in the hopes of stimulating further interest in MPS.

摘要

黏多糖贮积症(MPS)是一组罕见的溶酶体贮积病(LSD),具有多器官受累及严重症状。MPS在全球范围内以多种形式出现,但其发病率相对较低。MPS的流行类型在不同大陆有所不同,这表明它可能与地区和种族背景有关。酶缺乏导致的未降解糖胺聚糖(GAG)是MPS的主要病因。临床特征因具体酶缺乏而异,包括面部粗糙、认知迟缓、肝脾肿大、疝气、脊柱后凸侧弯、角膜混浊等。不同类型的症状通常相似,尤其是MPS I和II,但可能有可区分的特征,如MPS III中的严重神经问题和MPS VII中的胎儿水肿。这些临床特征有助于诊断,但在无症状阶段进行早期准确诊断对于获得更好的结果至关重要。包括尿液和血液GAG检测、酶测定和基因检测在内的新方法有助于诊断MPS并确定其亚型。造血干细胞移植(HSCT)和酶替代疗法(ERT)是MPS的传统治疗方法,但并非对所有MPS都有效。更新的治疗方法,如先进的ERT、基因治疗和底物减少疗法(SRT),提高了治疗效果。在本综述中,我们更新了关于这种疾病不同形式的临床表现、诊断和治疗的信息,希望能激发对MPS的进一步关注。

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