印度高免疫球蛋白 E 综合征的临床特征。
Clinical Profile of Hyper-IgE Syndrome in India.
机构信息
Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Front Immunol. 2021 Feb 26;12:626593. doi: 10.3389/fimmu.2021.626593. eCollection 2021.
Hyper-IgE Syndrome (HIES) is a rare inborn error of immunity (IEI) characterized by a constellation of symptoms related to susceptibility to skin and pulmonary infections, eczema, raised serum IgE (>2,000 IU/ml), craniofacial anomalies, and recurrent bone fractures. Data on HIES from the Indian subcontinent is scarce and restricted to small case series and case reports. This is the first compilation of national data on HIES. A total 103 cases clinically diagnosed and treated as HIES were analyzed from nine centers. Cases with clinical and/or molecular diagnosis of DOCK8 deficiency were not included. Patients were divided into two groups: group I for whom a heterozygous rare variant of STAT3 was identified, and group II, with clinical features similar to those of AD STAT3 deficiency, but without any genetic diagnosis. Genetic diagnosis was available in 27 patients (26.2%) and all harbored rare variants in the STAT3 gene. Majority of these STAT3 HIES patients presented with recurrent skin abscesses (77.7%) or pneumonia (62.9%) or both (59.2%). Other features included eczema (37%), candidiasis (55.5%), facial dysmorphism (55.5%), recurrent fractures (11.1%), and retained primary teeth (7.4%). infections were seen in a significant 18.5%. Mortality was seen in three subjects (11.1%). A similar trend in the clinical presentation was observed when all the 103 patients were analyzed together. Twenty percent of patients without a rare variant in the STAT3 gene had an NIH score of ≥40, whereas, 51.9% of STAT3 HIES subjects had scores below the cut off of ≥40. TH17 cell numbers were low in 10/11 (90.9%) STAT3 HIES tested. Rare variants observed were 8 in exon 21; 8 in exon 13; 3 in exon 10; 2 in exon 15, and one each in exon 6, 16, 17, 19, 22, and splice site downstream of exon 12. Seven variants were novel and included F174S, N567D, L404Sfs8, G419 =, M329K, T714I, R518X, and a splice site variant downstream of exon 12. The report includes seven novel STAT3 variants, including a rare linker domain nonsense variant and a CC domain variant. diseases were more frequent, compared to western literature.
高免疫球蛋白 E 综合征(HIES)是一种罕见的先天性免疫缺陷(IEI),其特征是一系列与皮肤和肺部感染、湿疹、血清 IgE 升高(>2000IU/ml)、颅面异常和复发性骨折易感性相关的症状。来自印度次大陆的关于 HIES 的数据很少,仅限于小病例系列和病例报告。这是首次对 HIES 的全国性数据进行汇编。 从 9 个中心分析了 103 例临床诊断和治疗为 HIES 的病例。未包括具有 DOCK8 缺乏症的临床和/或分子诊断的病例。患者分为两组:组 I 为鉴定出 STAT3 杂合罕见变异,组 II 为具有与 AD STAT3 缺乏相似的临床特征,但无任何遗传诊断。 在 27 名患者(26.2%)中获得了遗传诊断,他们均携带 STAT3 基因的罕见变异。这些 STAT3 HIES 患者大多数表现为复发性皮肤脓肿(77.7%)或肺炎(62.9%)或两者兼有(59.2%)。其他特征包括湿疹(37%)、念珠菌病(55.5%)、面部畸形(55.5%)、复发性骨折(11.1%)和滞留乳牙(7.4%)。 18.5%的患者存在严重感染。3 名患者死亡(11.1%)。当一起分析所有 103 名患者时,观察到相似的临床表型趋势。在没有 STAT3 基因罕见变异的 20%患者中,NIH 评分≥40,而 51.9%的 STAT3 HIES 患者的评分低于≥40 的截止值。在 11 名(90.9%)接受检测的 STAT3 HIES 患者中,TH17 细胞数量较低。观察到的罕见变异为 21 号外显子 8 个;13 号外显子 8 个;10 号外显子 3 个;15 号外显子 2 个,6 号、16 号、17 号、19 号、22 号外显子各 1 个,以及 12 号外显子下游的剪接位点 1 个。7 种变异是新的,包括 F174S、N567D、L404Sfs8、G419 =、M329K、T714I、R518X 和 12 号外显子下游的剪接位点变异。 该报告包括 7 种新的 STAT3 变异,包括罕见的连接域无义变异和 CC 结构域变异。 与西方文献相比,这些疾病更为常见。