本文报告了1例HADHB基因复合杂合变异导致的致死型线粒体三功能蛋白缺乏症(mitochondrial trifunctional protein deficiency,MTPD)。患儿生后24 h内起病,以“吃奶少伴心肌酶异常”为主诉在生后第4天转至南京医科大学附属儿童医院。入...本文报告了1例HADHB基因复合杂合变异导致的致死型线粒体三功能蛋白缺乏症(mitochondrial trifunctional protein deficiency,MTPD)。患儿生后24 h内起病,以“吃奶少伴心肌酶异常”为主诉在生后第4天转至南京医科大学附属儿童医院。入院时体格检查见精神稍萎靡,反应尚可,心肺腹无明显异常;实验室检查肌酸激酶同工酶及肌钙蛋白均偏高,心电图提示窦性心动过速、肢导联低电压;血液代谢筛查提示十四烯酰基肉碱及多种3-羟基肉碱均偏高;全外显子组测序结果示胎儿HADHB基因复合杂合变异[c.739C>T(p.Arg247Cys)和c.607C>T(p.Arg203Ter,272)]。随访至3月龄,患儿受凉后出现吃奶差、精神差,再入院后出现心力衰竭、呼吸衰竭等多脏器功能障碍表现,经治疗无效后死亡。致死型MTPD较为罕见,目前无有效治疗措施,预后差。对于新生儿期出现不明原因心肌病、低血糖、酸中毒等代谢异常表现,应警惕致死型MTPD可能,新生儿期基因检测可早期明确诊断。展开更多
Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defectiv...Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defective genes. M ELAS has unpredictable presentations and clinical course, and it can be commonly misdiagnosed as encephalitis, cerebral infarction, or brain neoplasms. This review aimed to update the diagnosis progress in MELAS, which may provide better understanding of the disease nature and help make the right diagnosis as well. Data Sources： The data used in this review came fi-om published peer review articles from October 1984 to October 2014, which were obtained fiom PubMed. The search term is ＂MELAS＂, Study Selection： lnfornmtion selected from those reported studies is mainly based on the progress on clinical tkatures, blood biochemistry, neuroimaging, muscle biopsy, and genetics in diagnosing MELAS. Results： MELAS has a wide heterogeneity in genetics and clinical manifestations. The relationship between mutations and phenotypes remains unclear. Advanced serial functional magnetic resonance imaging （MRI） can provide directional information on this disease. Muscle biopsy has meaningflil value in diagnosing MELAS, which shows the presence of ragged red fibers and mosaic appearance of cytochrome oxidase negative fibers. Genetic studies have reported that approximately 80% of MELAS cases are caused by the lnutation in.3243A〉G of the mitochondrial transfer RNA （Leu （UU R）） gene （MT-TLI）. Conclusions： MELAS involves multiple systems with variable clinical symptoms and recurrent episodes. The prognosis of MELAS patients depends on timely diagnosis. Therefore, overall diagnosis of MELAS should be based on the maternal inheritance family history, clinical manifestation, and findings from serial MR1, muscle biopsy, and genetics.展开更多
文摘本文报告了1例HADHB基因复合杂合变异导致的致死型线粒体三功能蛋白缺乏症(mitochondrial trifunctional protein deficiency,MTPD)。患儿生后24 h内起病,以“吃奶少伴心肌酶异常”为主诉在生后第4天转至南京医科大学附属儿童医院。入院时体格检查见精神稍萎靡,反应尚可,心肺腹无明显异常;实验室检查肌酸激酶同工酶及肌钙蛋白均偏高,心电图提示窦性心动过速、肢导联低电压;血液代谢筛查提示十四烯酰基肉碱及多种3-羟基肉碱均偏高;全外显子组测序结果示胎儿HADHB基因复合杂合变异[c.739C>T(p.Arg247Cys)和c.607C>T(p.Arg203Ter,272)]。随访至3月龄,患儿受凉后出现吃奶差、精神差,再入院后出现心力衰竭、呼吸衰竭等多脏器功能障碍表现,经治疗无效后死亡。致死型MTPD较为罕见,目前无有效治疗措施,预后差。对于新生儿期出现不明原因心肌病、低血糖、酸中毒等代谢异常表现,应警惕致死型MTPD可能,新生儿期基因检测可早期明确诊断。
基金a grant from the key project of the National Science Foundation of China
文摘Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defective genes. M ELAS has unpredictable presentations and clinical course, and it can be commonly misdiagnosed as encephalitis, cerebral infarction, or brain neoplasms. This review aimed to update the diagnosis progress in MELAS, which may provide better understanding of the disease nature and help make the right diagnosis as well. Data Sources： The data used in this review came fi-om published peer review articles from October 1984 to October 2014, which were obtained fiom PubMed. The search term is ＂MELAS＂, Study Selection： lnfornmtion selected from those reported studies is mainly based on the progress on clinical tkatures, blood biochemistry, neuroimaging, muscle biopsy, and genetics in diagnosing MELAS. Results： MELAS has a wide heterogeneity in genetics and clinical manifestations. The relationship between mutations and phenotypes remains unclear. Advanced serial functional magnetic resonance imaging （MRI） can provide directional information on this disease. Muscle biopsy has meaningflil value in diagnosing MELAS, which shows the presence of ragged red fibers and mosaic appearance of cytochrome oxidase negative fibers. Genetic studies have reported that approximately 80% of MELAS cases are caused by the lnutation in.3243A〉G of the mitochondrial transfer RNA （Leu （UU R）） gene （MT-TLI）. Conclusions： MELAS involves multiple systems with variable clinical symptoms and recurrent episodes. The prognosis of MELAS patients depends on timely diagnosis. Therefore, overall diagnosis of MELAS should be based on the maternal inheritance family history, clinical manifestation, and findings from serial MR1, muscle biopsy, and genetics.
