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新生儿脑病的临床特征和潜在遗传病因:一项大型队列研究。

Clinical features and underlying genetic causes in neonatal encephalopathy: A large cohort study.

机构信息

Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China.

Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.

出版信息

Clin Genet. 2020 Oct;98(4):365-373. doi: 10.1111/cge.13818. Epub 2020 Sep 4.

Abstract

This study aimed to investigate the potential genetic causes of neonatal encephalopathy (NE) in a large cohort of Chinese patients. We included 366 neonates with encephalopathy. Whole exome sequencing was performed to assess the potential molecular defects. In this study, 43 patients (11.7%) were identified with pathogenic or likely pathogenic variants and 10 patients (2.7%) carried variants with unknown significance. Compared with patients without genetic findings (28.9%), patients with genetic findings (96.2%) displayed a significant higher incidence of seizure (P = .0009); however, a lower frequency of abnormal magnetic resonance imaging (MRI) results (P < .0001). Epileptic encephalopathy related genes account for nearly half (46.4%) of all genetic defects of NE with seizures. Follow-up results revealed genetic diagnosis, seizure and severe abnormal electroencephalograph results were significantly associated with high risk of developmental delay (P < .05). This study increases the understanding of genetic contribution to NE. Our findings suggest that the full-term NE patients with seizure, the greater the possibility of genetic diseases. However, for newborns especially the preterm babies with abnormal MRI findings, there is smaller possibility of genetic diseases. NE caused from genetic diseases have poor prognosis, and intensive intervention and follow-up is necessary for these newborns.

摘要

本研究旨在调查中国大样本队列中新生儿脑病(NE)的潜在遗传病因。我们纳入了 366 例脑病新生儿。进行全外显子组测序以评估潜在的分子缺陷。在这项研究中,43 名患者(11.7%)被鉴定出存在致病性或可能致病性变异,10 名患者(2.7%)携带意义不明的变异。与无遗传发现的患者(28.9%)相比,有遗传发现的患者(96.2%)癫痫发作的发生率显著更高(P =.0009);然而,异常磁共振成像(MRI)结果的频率较低(P < .0001)。与癫痫相关的脑病基因占所有具有癫痫发作的 NE 遗传缺陷的近一半(46.4%)。随访结果显示,遗传诊断、癫痫发作和严重异常脑电图结果与发育迟缓的高风险显著相关(P < .05)。本研究增加了对 NE 遗传贡献的理解。我们的发现表明,具有癫痫发作的足月 NE 患者,遗传疾病的可能性越大。然而,对于新生儿,特别是具有异常 MRI 发现的早产儿,遗传疾病的可能性较小。由遗传疾病引起的 NE 预后较差,这些新生儿需要进行强化干预和随访。

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