Zhou Q J, Gong P, Jiao X R, Yang Z X
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Feb 18;55(1):181-185. doi: 10.19723/j.issn.1671-167X.2023.01.028.
To summarize the clinical diagnosis and treatment process and genetic test results and characteristics of one child with Angelman syndrome (AS) complicated with oculocutaneous albinism type 2 (OCA2), and to review the literature. "Angelman syndrome" "P gene" and "Oculocutaneous albinism type 2" were used as keywords to search at CNKI, Wanfang, and PubMed databases (from creation to December 2019). Then all the patients were analyzed. The patient in this study was a girl aged 1 year. After birth, she was found to present as white body, yellow hair, and nystagmus. She could raise her head at the age of 2 months and turn over at the age of 7 months. The head circumference was 42 cm and she could not sit alone or speak at present. Trio-based exome sequencing revealed that the patient carried a homozygous mutation of c.168del (p.Gln58ArgfsTer44) in the P gene, and her father was heterozygous and her mother was wild-type. The detection of copy number variation showed deletion on the maternal chromosome at 15q11.2-13.1 region (P gene located in this region) in the patient. Until December 2019, a total of 4 cases in the 4 literature had been reported. Adding our case here, the 5 cases were summarized and found that all the cases showed white skin, golden hair, and shallow iris after birth. Comprehensive developmental delay was found around 6 months of age after birth, and the language remained undeveloped in 2 cases till follow-up into childhood. Seizures occurred in 4 patients. Two cases had ataxia. All the 5 cases had acquired microcephaly. Two cases had a family history of albinism. Electroencephalogram monitoring was completed in 3 cases and the results were abnormal. Genetic tests showed that all the 5 cases had deletion on maternal chromosome at 15q11-13 region. Four cases carried mutation of P gene on paternal chromosome. And 1 case was clinically diagnosed as OCA2 without P gene test. AS combined with OCA2 is relatively rare. OCA2 is easily diagnosed based on the obvious clinical manifestations after birth. When combined with clinical manifestations such as neurodevelopmental delay, it might indicate the possibility of AS that is hardly diagnosed clinically at an early stage. Genetic tests can reveal the cross-genetic phenomenon of AS and OCA2 and the complex of them can be eventually diagnosed.
总结1例天使综合征(AS)合并2型眼皮肤白化病(OCA2)患儿的临床诊断、治疗过程、基因检测结果及特点,并进行文献复习。以“天使综合征”“P基因”及“2型眼皮肤白化病”为关键词,检索中国知网、万方及PubMed数据库(建库至2019年12月),对所有患者进行分析。本研究中的患者为1岁女童,出生后即发现全身皮肤白皙、头发发黄、眼球震颤。2个月时能抬头,7个月时会翻身。头围42 cm,目前不能独坐,不会说话。基于三联体的外显子组测序显示,患者P基因存在c.168del(p.Gln58ArgfsTer44)纯合突变,其父亲为杂合子,母亲为野生型。拷贝数变异检测显示,患者母源15号染色体15q11.2 - 13.1区域(P基因位于该区域)存在缺失。截至2019年12月,4篇文献中共报道4例。加上本文病例,对这5例进行总结发现,所有病例出生后均表现为皮肤白皙、头发金黄、虹膜颜色浅。出生后6个月左右出现全面发育迟缓,2例随访至儿童期语言仍未发育。4例患者出现癫痫发作。2例有共济失调。5例均有后天小头畸形。2例有白化病家族史。3例完成脑电图监测,结果异常。基因检测显示,5例患者母源15号染色体11 - 13区域均有缺失。4例父源染色体携带P基因突变。1例临床诊断为OCA2,未进行P基因检测。AS合并OCA2较为罕见。OCA2出生后临床表现明显,易于诊断。当合并神经发育迟缓等临床表现时,可能提示AS的可能性,而AS早期临床难以诊断。基因检测可揭示AS与OCA2的交叉遗传现象,最终明确二者的合并情况。