摘要
目的:探讨RUNX1胚系突变导致的家族性血小板疾病并急性髓系白血病倾向(FPD/AML)患儿及其家族成员的临床特点及基因突变情况。方法:对2019年10月中国医学科学院血液病医院儿童血液诊疗中心收治的1例FPD/AML患儿及部分家族成员的临床资料及基因突变结果进行分析。并以"RUNX1胚系突变""家族性血小板疾病并急性髓系白血病倾向""RUNX1 germline mutation""FPD/AML"为检索词,检索建库至2020年9月中文数据库(中国知网数据库、万方数据库及维普数据库)及PubMed数据库进行文献复习。结果:患儿为5岁男孩,因发现血小板减少3年入院。体格检查提示存在皮肤出血点,其他无明显异常。辅助检查:外周血常规示WBC 6.38×10^(9)/L,HGB 113 g/L,PLT 54×10^(9)/L,中性粒细胞绝对计数4.03×10^(9)/L,血小板平均体积(MPV)9.1 fl。骨髓涂片提示巨核系发育异常。涂片免疫CD42b及CD41酶标提示存在小巨核细胞。基因检测提示RUNX1(exon3:c.520delC:p.R174Efs^(*)10,NM_001001890)的移码突变,经口腔上皮细胞验证为胚系突变。家族史中共有5名家族成员存在血液系统疾病并相继死亡。患儿母亲及外祖父先后进行了与血液肿瘤疾病相关的137个基因热点区域的基因检测,均检测到与患儿相同位点的RUNX1移码突变,但是三人的临床症状十分不同。文献检索共检索到相关英文文献37篇,报道了70多个FPD/AML家族,未检索到相关中文文献。结论:RUNX1胚系突变是导致FPD/AML的病因,进展为髓系恶性肿瘤的风险极高,携带相同突变的家族成员可能表现出非常不同的临床症状和严重程度。
Objective To analyze the clinical features,bone marrow features,and gene mutations of children with familial platelet disorder with predisposition to myeloid leukemia(FPD/AML)caused by a RUNX1 germline mutation as well as their family members.Methods The clinical data and gene mutations of a child with FPD/AML hospitalized in the Pediatric Blood Disease Center,Institute of Hematology and Blood Diseases Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,and some family members were extracted and analyzed.The literature was searched using"RUNX1 germline mutation"and"FPD/AML"as keywords in the Chinese databases;also PubMed was reviewed until September 2020.Results A male patient aged 5 with dermatorrhagia was admitted due to thrombocytopenia for more than 3 years.The laboratory tests revealed a peripheral blood routine(WBC 6.38×10^(9)/L,HGB 113 g/L,PLT 54×10^(9)/L,NEUT 4.03×10^(9)/L,and MPV 9.1 fl).Bone marrow smear revealed dysplasia of megakaryocytes.The immunohistochemistry for CD42b and CD41 highlighted small mononuclear megakaryocytes.Second generation sequencing revealed RUNX1(exon3:c.520delC:p.R174Efs^(*)10,NM_001001890)frameshift mutations,and its germline mutation was verified via genetic detection of oral epithelial cells.Five members of the family had blood diseases and successively died.The child's mother and maternal grandfather were sequenced for the second generation,and RUNX1 frameshift mutation was detected in the same locus as the child.However,the clinical features among them were different.A total of 37 English literatures were retrieved,and more than 70 FPD/AML families were reported.No relevant Chinese literature was retrieved.Conclusion Runx1 germline mutations cause FPD/AML with a high risk of progression to myeloid malignancy.Family members carrying the same mutations may exhibit different clinical features and severity.
作者
张然然
陈晓娟
任媛媛
杨文钰
竺晓凡
Zhang Ranran;Chen Xiaojuan;Ren Yuanyuan;Yang Wenyu;Zhu Xiaofan(Pediatric Blood Disease Center,State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2021年第4期308-312,共5页
Chinese Journal of Hematology
