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绘制先天性糖基化障碍(CDG)的诊断之旅:来自社区的见解。

Mapping the diagnostic odyssey of congenital disorders of glycosylation (CDG): insights from the community.

机构信息

UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal.

Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal.

出版信息

Orphanet J Rare Dis. 2024 Nov 1;19(1):407. doi: 10.1186/s13023-024-03389-2.

Abstract

BACKGROUND

Congenital disorders of glycosylation (CDG) are a group of rare metabolic diseases with heterogeneous presentations, leading to substantial diagnostic challenges, which are poorly understood. Therefore, this study aims to elucidate this diagnostic journey by examining families' and professionals' experiences.

RESULTS AND DISCUSSION

A questionnaire was designed for CDG families and professionals, garnering 160 and 35 responses, respectively. Analysis revealed the lack of seizures as a distinctive feature between PMM2-CDG (11.2%) with Other CDG (57.7%) at symptom onset. Hypotonia and developmental disability were prevalent symptoms across all studied CDG. Feeding problems were identified as an early onset symptom in PMM2-CDG (Cramer's V (V) = 0.30, False Discovery Rate (FDR) = 3.8 × 10), and hypotonia in all studied CDG (V = 0.34, FDR = 7.0 × 10). The average time to diagnosis has decreased in recent years (now ~ 3.9 years), due to advancements namely the increased use of whole genome and exome sequencing. However, misdiagnoses remain prevalent (PMM2-CDG - 44.9%, non-PMM2-CDG - 64.8%). To address these challenges, we propose adapting medical training to increase awareness of CDG and other rare diseases, ongoing education for physicians, the development of educational resources for relevant medical units, and empowerment of families through patient organizations and support networks.

CONCLUSION

This study emphasizes the crucial role of community-centered research, and the insights families can offer to enhance CDG management. By pinpointing existing gaps and needs, our findings can inform targeted interventions and support systems to improve the lives of those impacted by CDG.

摘要

背景

先天性糖基化障碍(CDG)是一组具有异质性表现的罕见代谢疾病,导致诊断挑战巨大,目前对此了解甚少。因此,本研究旨在通过考察家庭和专业人员的经验来阐明这一诊断过程。

结果与讨论

我们为 CDG 家庭和专业人员设计了一份问卷,分别收到 160 份和 35 份回复。分析显示,在症状出现时,PMM2-CDG(11.2%)与其他 CDG(57.7%)之间缺乏癫痫发作是一个显著特征。所有研究的 CDG 中均普遍存在肌张力低下和发育障碍。喂养问题被确定为 PMM2-CDG 的早期发病症状(Cramer's V(V)=0.30,False Discovery Rate(FDR)=3.8×10),所有研究的 CDG 中均存在肌张力低下(V=0.34,FDR=7.0×10)。近年来,由于全基因组和外显子组测序的广泛应用,诊断时间有所缩短(现在约为 3.9 年)。然而,误诊仍然很普遍(PMM2-CDG-44.9%,非-PMM2-CDG-64.8%)。为了应对这些挑战,我们建议调整医学培训,以提高对 CDG 和其他罕见疾病的认识,为医生提供持续教育,为相关医疗单位开发教育资源,并通过患者组织和支持网络为家庭提供赋权。

结论

本研究强调了以社区为中心的研究的重要性,以及家庭能够提供的改善 CDG 管理的见解。通过指出现有差距和需求,我们的研究结果可以为有针对性的干预和支持系统提供信息,以改善受 CDG 影响的人的生活。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/331e/11529564/6978dfecfee7/13023_2024_3389_Fig1_HTML.jpg

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