摘要
目的 分析我国河南地区伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病（CADASIL）患者的临床、影像学特征及NOTCH3基因突变热点的分布.方法 收集2012-2016年在郑州大学人民医院神经内科就诊的通过基因或病理确诊的CADASIL患者,回顾性分析其临床及影像学特征,同时总结分析河南地区NOTCH3基因突变的分布热点.结果 共收集确诊为CADASIL的患者37例,分别来自19个相互独立的家系,其中17个家系以基因检测确诊,另2个家系经病理确诊.共确诊13个NOTCH3基因突变位点.17个基因确诊的家系中有1个家系的突变位于3号外显子,4个位于4号外显子,1个位于8号外显子,8个位于11号外显子,2个位于13号外显子,1个位于20号外显子.37例CADASIL患者中已有症状者27例,以卒中和认知功能障碍多见,还有脑出血、头晕、秃头、腰痛、帕金森表现等少见症状.27例已发病者中有12例合并脑血管病危险因素.22例患者行头颅MRI检查,结果显示白质病变主要集中在脑干、基底节、皮质下、颞极、外囊等部位,且颞极白质病变出现比例多于外囊（19∶7）,在T2WI序列表现为高信号.结论 CADASIL患者可合并危险因素存在;T2WI发现颞极高信号比外囊多见.河南地区的CADASIL患者NOTCH3突变热点集中在11号和4号外显子.
Objective To analyze the clinical, imaging characteristics and NOTCH3 mutations of cerebral autosomal dominant arteriopathy with the subcortical infarcts and leukoencephalopathy （CADASIL） in Henan, China.Methods CADASIL patients diagnosed by gene or biopsy in People＇s Hospital of Zhengzhou University between 2012-2016 were recruited.Clinical and imaging features of these patients were analyzed retrospectively.The distribution of NOTCH3 gene mutations hotspots was described in Henan region at the same time.Results There were 37 patients from 19 families who were diagnosed as CADASIL by genetic testing or biopsy, 27 of whom had symptoms of CADASIL.Two families were confirmed by pathological examination and 17 by genetic testing.Of these 17 families, 13 mutations were found.Mutations in exon 11 were found in eight families, in exon 4 were detected in four families, and in exon 13 were found in two families.Mutation in exons 3, 8 and 20 was detected in one family respectively.Most patients presented with stroke and several presented with cognitive decline.Twelve patients had been attacked by risk factors.Magnetic resonance imaging （MRI） was performed on 22 patients.White-matter lesions were distributed in brain stem, basal ganglia, subcortical, temporal pole, external capsule.There were 19 patients with white-matter lesions in temporal pole and seven in capsula externa, showed as a high signal in T2WI.Conclusions CADASIL patients can be associated with risk factors.T2WI hyperintensities in the anterior temporal lobe were more common than that in the capsular external.Exon 11 and exon 4 were the hotspots for the NOTCH3 mutation in Henan patients.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2017年第8期613-618,共6页
Chinese Journal of Neurology
关键词
脑动脉疾病
遗传
基因
显性
突变
危险因素
磁共振成像
Cerebral arterial diseases
Heredity
Genes
dominant
Mutation
Risk factors
Magnetic resonance imaging
