中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (6): 459-463.

• 论著 • 上一篇    下一篇

ATP7A基因内含子突变致Menkes病1家系2例报告

张晓青1,孙素真1,吴文娟1,刘康1,王晶2   

  1. 河北省儿童医院 河北石家庄,0500311 神经内科,2 影像科
  • 收稿日期:2018-08-03 修回日期:2018-10-16 出版日期:2018-12-25 发布日期:2018-12-25
  • 通讯作者: 孙素真

A family report of 2 cases with Menkes disease caused by intron mutation of ATP7A gene

ZHANG Xiao-qing1, SUN Su-zhen1, WU Wen-juan1, LIU Kang1, WANG Jing2   

  1. Children's Hospital of Hebei Province, Shijiazhuang 050031, China; 1 Department of Neurology, 2 Imaging Department
  • Received:2018-08-03 Revised:2018-10-16 Online:2018-12-25 Published:2018-12-25
  • Contact: SUN Su-zhen

摘要: 目的探讨Menkes病的临床和实验室特点。方法对1家系2例确诊为Menkes病患儿的临床、实验室检查、影像学资料及基因表现进行回顾性分析。结果2例患儿均为男童,先证者生后4个月起病,肤色白、脸颊饱满、皮肤松弛、毛发细、色淡卷曲,有漏斗胸,有癫、发育迟滞。先证者哥哥自幼发育落后,康复治疗无效,1年前死亡。2例患儿血浆铜蓝蛋白分别为 80 mg·L-1及 92.4 mg·L-1。患儿的头发在光镜下观察有扭曲、串珠样改变;先证者颅脑MRI髓鞘化延迟,双侧大脑、小脑萎缩样改变,脑表面血管迂曲增多,双侧基底节及大脑脚异常信号,颅脑MRA+MRV示:大动脉走行迂曲,动脉分支及表浅静脉扭曲成团。先证者基因学检查未发现ATP7A基因存在大片段变异,但ATP7A基因c.2172+5_2172TGAAT(编码区第2172号核苷酸后内含子中第5与第6位核苷酸间插入TGAAT)的微小剪切变异,先证者哥哥与其变异位点相同,母亲为表型正常的携带者。结论Menkes病为遗传性的铜代谢障碍性疾病,以进行性加重的神经损害为主要表现,有特殊面容和毛发改变,脑萎缩和脑血管的形态改变,结合实验室检查、颅脑影像及基因检测可确诊。

Abstract: ObjectiveTo investigate the clinical and laboratory characteristics of Menkes disease.MethodsThe clinical, laboratory, imaging and gene expression of 2 children diagnosed as Menkes's disease in 1 family were retrospectively analyzed.ResultsTwo children were all boys.The clinical manifestations of the younger brother began at 4 months after birth, including pale skin, pudgy cheeks, inguinal hernia, peculiar kinkyhair, funnel chest, epilepsy and mental retardation. The child's brother developed backward since childhood, and the rehabilitation treatment was invalid,died 1 year ago. Plasma ceruloplasmin in 2 cases was 80 mg·L-1 and 92.4 mg·L-1, respectively. Two children's hair was observed under the light microscope with distorted and beaded changes. The delayed myelination of the brain MRI, the changes of bilateral cerebral and cerebellar atrophy, the increase of the cerebral surface vascular circuitous, bilateral basal ganglia and the abnormal signal of the cerebral foot were observed in the probard. The brain MRA+MRV showed that the large arteries were circuitous, the branches of the arteries and the superficial vein twisted into a group. The child did not find the ATP7A gene existence of large fragment variation, However, there is a small variation of c.2172+5_2172TGAAG (TGAAT was inserted between the 5th and 6th nucleotides in intron after nucleotide 2 172 of coding region) in ATP7A gene, which is shear variation.The brother was the same as the heterotopic, and the mother was a normal carrier. ConclusionMenkes disease is a hereditary copper metabolic disorder. The main manifestations of the progressive neurodamage are the special facial features and hair changes, as well as the morphological changes of brain atrophy and cerebral vessels, combined with laboratory examination, head image and gene detection can be confirmed.