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在资源有限的环境下,通过精准分析进行婴儿期扩展筛查以识别先天性代谢缺陷的临床诊断现状。

Current Scenario of Clinical Diagnosis to Identify Inborn Errors of Metabolism with Precision Profiling for Expanded Screening in Infancy in a Resource-limited Setting.

作者信息

Mukherjee Sukhes, Kotnis Ashwin, Ray Suman Kumar, Vaidyanathan Kannan, Singh Snighdha, Mittal Rishabh

机构信息

Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh-462020, India.

Independent Researcher, India.

出版信息

Curr Pediatr Rev. 2022;19(1):34-47. doi: 10.2174/1573396318666220404113732.

DOI:10.2174/1573396318666220404113732
PMID:35379152
Abstract

Inborn errors of metabolism (IEM) are a diverse collection of abnormalities that cause a variety of morbidities and mortality in children and are classified as uncommon genetic diseases. Early and accurate detection of the condition can save a patient's life. By aiding families as they navigate the experience of having a child with an IEM, healthcare practitioners have the chance to reduce the burden of negative emotional consequences. New therapeutic techniques, such as enzyme replacement and small chemical therapies, organ transplantation, and cellular and gene-based therapies using whole-genome sequencing, have become available in addition to traditional medical intake and cofactor treatments. In the realm of metabolic medicine and metabolomics, the twentyfirst century is an exciting time to be alive. The availability of metabolomics and genomic analysis has led to the identification of a slew of novel diseases. Due to the rarity of individual illnesses, obtaining high-quality data for these treatments in clinical trials and real-world settings has proven difficult. Guidelines produced using standardized techniques have helped enhance treatment delivery and clinical outcomes over time. This article gives a comprehensive description of IEM and how to diagnose it in patients who have developed clinical signs early or late. The appropriate use of standard laboratory outcomes in the preliminary patient assessment is also emphasized that can aid in the ordering of specific laboratory tests to confirm a suspected diagnosis, in addition, to begin treatment as soon as possible in a resource limiting setting where genomic analysis or newborn screening facility is not available.

摘要

先天性代谢缺陷(IEM)是一系列多样的异常情况,可导致儿童出现各种疾病和死亡,被归类为罕见的遗传疾病。早期准确检测该病症可挽救患者生命。通过在家庭应对家中有IEM患儿的经历时提供帮助,医疗从业者有机会减轻负面情绪后果的负担。除了传统的药物摄入和辅助因子治疗外,新的治疗技术,如酶替代和小分子化学疗法、器官移植以及使用全基因组测序的细胞和基因疗法也已出现。在代谢医学和代谢组学领域,21世纪是一个令人兴奋的时代。代谢组学和基因组分析的可用性导致了一系列新疾病的发现。由于个别疾病罕见,在临床试验和实际临床环境中获取这些治疗的高质量数据已被证明很困难。随着时间的推移,使用标准化技术制定的指南有助于改善治疗实施和临床结果。本文全面描述了IEM以及如何在早期或晚期出现临床症状的患者中进行诊断。还强调了在初步患者评估中适当使用标准实验室结果,这有助于安排特定的实验室检查以确认疑似诊断,此外,在没有基因组分析或新生儿筛查设施的资源有限的环境中尽快开始治疗。

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