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亨廷顿病的预测性基因检测:神经科医生是否应该参与?

Predictive genetic testing in Huntington's disease: should a neurologist be involved?

机构信息

Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.

Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Eur J Hum Genet. 2020 Sep;28(9):1205-1209. doi: 10.1038/s41431-020-0633-9. Epub 2020 May 13.

Abstract

International guidelines on Huntington's Disease recommend neurological examination in the predictive testing trajectory. Experiences and personal wishes of persons at risk of Huntington's Disease regarding this topic have never been evaluated. The objective was to provide an overview of the experiences of Dutch at-risk persons, opting for predictive testing, in consulting a neurologist before and after DNA analysis. Persons who were counseled in four Dutch clinics between 2017 and 2019 were retrospectively or prospectively approached for a questionnaire which listed topics as experiences with consultation and personal wishes. From 71 participants, 44 participants visited a neurologist. 41 participants indicated their visit to a neurologist as positive (93.2%). The majority of participants (n = 59) desired consulting a neurologist. Thirty-two participants indicated consultation shortly after (Desired After Group) and twenty-seven before DNA analysis (Desired Before Group) as personal wish. The Desired Before Group consisted of a significantly higher number of participants who actually consulted a neurologist before predictive testing (n = 26) compared with the number of participants who actually consulted a neurologist after DNA analysis in the Desired After Group (n = 11) (p < 0.001). The Desired After Group (n = 19) had a significantly higher number of Huntington's disease gene expansion carriers compared with the Desired Before Group (n = 5) (p 0.003). Participants are content with consultation. However, persons without the gene expansion still feel the need to get in touch with a neurologist. Therefore, offering a consultation with a neurologist before DNA analysis might be beneficial for all.

摘要

国际亨廷顿病指南建议在预测性检测轨迹中进行神经学检查。然而,从未评估过亨廷顿病风险者对这一主题的经验和个人意愿。本研究旨在概述选择进行预测性检测的荷兰风险者在 DNA 分析之前和之后咨询神经科医生的经历。2017 年至 2019 年期间,在四家荷兰诊所接受咨询的患者被回顾性或前瞻性地调查是否愿意填写一份列出咨询经历和个人意愿的问卷。在 71 名参与者中,有 44 名参与者曾咨询过神经科医生。41 名参与者认为他们的神经科医生就诊是积极的(93.2%)。大多数参与者(n=59)希望咨询神经科医生。32 名参与者表示希望在 DNA 分析后(期望在分析后组)进行咨询,27 名参与者表示希望在 DNA 分析前(期望在分析前组)进行咨询。与 DNA 分析后组(n=11)相比,期望在分析前组中实际上在预测性检测前咨询神经科医生的参与者(n=26)明显更多(p<0.001)。期望在分析后组(n=19)的亨廷顿病基因突变携带者明显多于期望在分析前组(n=5)(p<0.003)。参与者对咨询感到满意。然而,没有基因突变的人仍然感到需要与神经科医生联系。因此,在 DNA 分析之前提供与神经科医生的咨询可能对所有人都有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef8f/7641196/0207b1672db7/41431_2020_633_Fig1_HTML.jpg

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