人腺苷脱氨酶 2 缺乏症 - 血液学家的诊断难题。
Deficiency of Human Adenosine Deaminase Type 2 - A Diagnostic Conundrum for the Hematologist.
机构信息
Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
出版信息
Front Immunol. 2022 May 3;13:869570. doi: 10.3389/fimmu.2022.869570. eCollection 2022.
Deficiency of adenosine deaminase type 2 (DADA2) was first described in 2014 as a monogenic cause of polyartertitis nodosa (PAN), early onset lacunar stroke and livedo reticularis. The clinical phenotype of DADA2 is, however, very broad and may involve several organ systems. Apart from vasculitis, children may present with i) Hematological manifestations (ii) Lymphoproliferation and iii) Immunodeficiencies. Patients with DADA2 can have variable patterns of cytopenias and bone marrow failure syndromes. Patients with DADA2 who have predominant haematological manifestations are associated with ADA2 gene variants that result in minimal or no residual ADA2 activity. Lymphoproliferation in patients with DADA2 may range from benign lymphoid hyperplasia to lymphoreticular malignancies. Patients may present with generalized lymphadenopathy, splenomegaly, autoimmune lymphoproliferative syndrome (ALPS) like phenotype, Hodgkin lymphoma, T-cell large granular lymphocytic infiltration of bone marrow and multicentric Castleman disease. Immunodeficiencies associated with DADA are usually mild. Affected patients have variable hypogammaglobulinemia, decrease in B cells, low natural killer cells, common variable immunodeficiency and rarely T cell immunodeficiency. To conclude, DADA2 has an extremely variable phenotype and needs to be considered as a differential diagnosis in diverse clinical conditions. In this review, we describe the evolving clinical phenotypes of DADA2 with a special focus on haematological and immunological manifestations.
腺苷脱氨酶 2 型(DADA2)缺乏症于 2014 年首次被描述为结节性多动脉炎(PAN)、早发性腔隙性脑梗死和网状青斑的单基因病因。然而,DADA2 的临床表型非常广泛,可能涉及多个器官系统。除了血管炎,儿童可能表现为 i)血液学表现(ii)淋巴增殖和 iii)免疫缺陷。DADA2 患者可能有不同模式的血细胞减少和骨髓衰竭综合征。具有主要血液学表现的 DADA2 患者与 ADA2 基因变异相关,这些变异导致 ADA2 活性最小或无残留。DADA2 患者的淋巴增殖可从良性淋巴组织增生到淋巴网状恶性肿瘤。患者可能表现为全身淋巴结肿大、脾肿大、自身免疫性淋巴增殖综合征(ALPS)样表型、霍奇金淋巴瘤、骨髓 T 细胞大颗粒淋巴细胞浸润和多中心 Castleman 病。与 DADA 相关的免疫缺陷通常较轻。受影响的患者有不同程度的低丙种球蛋白血症、B 细胞减少、自然杀伤细胞减少、常见可变免疫缺陷,很少有 T 细胞免疫缺陷。总之,DADA2 的表型极其多样,需要在各种临床情况下考虑作为鉴别诊断。在这篇综述中,我们描述了 DADA2 不断演变的临床表型,特别关注血液学和免疫学表现。