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先天性肾上腺皮质增生症疑似患者的综合基因检测:一项回顾性分析

Comprehensive Genetic Testing of : A Retrospective Analysis in Patients with Suspected Congenital Adrenal Hyperplasia.

作者信息

Nan Madalina Nicoleta, Roig Rosa, Martínez Susana, Rives Jose, Urgell Eulàlia, Espinós Juan José, Tirado Mireia, Carreras Gemma, Aulinas Anna, Webb Susan M, Corcoy Rosa, Blanco-Vaca Francisco, Tondo Mireia

机构信息

Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau-IIB Sant Pau, 08041 Barcelona, Spain.

Servei de Ginecologia, Hospital de la Santa Creu i Sant Pau-IIB Sant Pau, 08041 Barcelona, Spain.

出版信息

J Clin Med. 2021 Mar 12;10(6):1183. doi: 10.3390/jcm10061183.

Abstract

The most common form of congenital adrenal hyperplasia (CAH) results from a deficiency of the 21-hydroxylase enzyme (21-OHD), presenting with a broad spectrum of clinical phenotypes according to the gene mutations. Of the 59 patients with suspected CAH, 62.7% presented a positive genetic result. Of them, 78.4% and 18.9% presented with non-classical and classical forms, respectively. An overall phenotype-genotype correlation of 88.9% was observed. Biochemically, 17-hydroxiprogesterone concentrations were significantly higher in genetically confirmed patients. Genetically, 36 patients presented with previously reported pathogenic variants, and one presented a new variant in homozygosis. Among the 74 alleles tested, point mutations were found in 89.2% and large rearrangements were found in the rest. The most prevalent pathogenic variant was p.(Val282Leu). The inclusion of relatives revealed one further case. Interestingly, 87.5% of relatives were carriers of a pathogenic variant, including two siblings initially classified as genetically positive. In addition, the study of male partners with gestational desire identified several carriers of mild mutations. Studying the allelic distribution of the variants also allowed for reclassifying one patient. In conclusion, a genetic approach including Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA) analysis, and allelic distribution of the pathogenic variants represents a beneficial tool for better classifying patients with 21-OHD.

摘要

先天性肾上腺皮质增生症(CAH)最常见的形式是由21-羟化酶(21-OHD)缺乏引起的,根据基因突变呈现出广泛的临床表型。在59例疑似CAH患者中,62.7%的患者基因检测结果呈阳性。其中,78.4%和18.9%的患者分别表现为非经典型和经典型。观察到总体表型-基因型相关性为88.9%。生化方面,基因确诊患者的17-羟孕酮浓度显著更高。基因方面,36例患者呈现先前报道的致病变异,1例患者呈现纯合子新变异。在检测的74个等位基因中,89.2%发现点突变,其余发现大片段重排。最常见的致病变异是p.(Val282Leu)。对亲属的检测又发现1例病例。有趣的是,87.5%的亲属是致病变异携带者,包括最初基因检测呈阳性的2名兄弟姐妹。此外,对有妊娠意愿的男性伴侣的研究发现了几名轻度突变携带者。对变异等位基因分布的研究还使得对1例患者进行了重新分类。总之,包括桑格测序、多重连接依赖探针扩增(MLPA)分析以及致病变异等位基因分布在内的基因检测方法是更好地对21-OHD患者进行分类的有益工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/35b6/8001222/9dfdfc61fee5/jcm-10-01183-g001.jpg

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