中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2011年
1期
1-6
,共6页
才智勇%章友康%王素霞%房秋园%刘林昌%黄昱%张宏%郑欣%陈育青%邹万忠
纔智勇%章友康%王素霞%房鞦園%劉林昌%黃昱%張宏%鄭訢%陳育青%鄒萬忠
재지용%장우강%왕소하%방추완%류림창%황욱%장굉%정흔%진육청%추만충
法布里病%肾小球基底膜%薄基底膜肾病%基因突变%GLA基因%COL4A3基因
法佈裏病%腎小毬基底膜%薄基底膜腎病%基因突變%GLA基因%COL4A3基因
법포리병%신소구기저막%박기저막신병%기인돌변%GLA기인%COL4A3기인
Fabry disease%Glomerular basement membrane%Thin basement membrane nephropathy%Mutation%GLA gene%COL4A3 gene
目的 了解具有两种遗传性疾病,即Fabry病并发薄基底膜肾病(TBMN)的临床病理和基因突变特点以及家系患病情况.方法 总结分析本院收治的1例41岁女性Fabrv病并发TBMN患者的临床病理特征和基因突变情况,同时对家系成员进行调查及相关检测.结果 先证者呈现典型的Fabry病的肾外临床表现,包括皮疹、神经痛、眩晕、耳鸣、肥厚型心肌病等,同时亦有蛋白尿、镜下血尿及高血压等肾脏受累表现;肾活检光镜下病理改变为局灶性节段性肾小球硬化(FSGS),部分足细胞空泡变性;电镜下肾小球脏层上皮细胞胞质内多数髓磷脂小体形成,肾小球基底膜(GBM)弥漫性变薄,厚度为(216±31)nm.家系调查及基因突变检测显示先证者女儿除有典型Fabry病肾外表现外,亦有以血尿为主的肾脏症状.先证者的1个妹妹仅表现为镜下血尿.先证者及其女儿α-半乳糖苷酶A(α-Gal A)活性分别为33和75活性单位(正常参考值为100～500活性单位),且2人均携带新发现的GLA基因突变--1208ins21 bp及COL4A3基因多态性--c:3627 G＞A(p:M1209I).仅表现为镜下血尿的先证者的妹妹仅携带COL4A3基因的c:3627 G＞A(p:M1209I)多态性,α-Gal A活性正常,无GLA基因突变.结论 对于Fabry肾病患者呈现血尿,尤其是表现为家族性血尿时,应考虑并认真排除并发TBMN的可能.
目的 瞭解具有兩種遺傳性疾病,即Fabry病併髮薄基底膜腎病(TBMN)的臨床病理和基因突變特點以及傢繫患病情況.方法 總結分析本院收治的1例41歲女性Fabrv病併髮TBMN患者的臨床病理特徵和基因突變情況,同時對傢繫成員進行調查及相關檢測.結果 先證者呈現典型的Fabry病的腎外臨床錶現,包括皮疹、神經痛、眩暈、耳鳴、肥厚型心肌病等,同時亦有蛋白尿、鏡下血尿及高血壓等腎髒受纍錶現;腎活檢光鏡下病理改變為跼竈性節段性腎小毬硬化(FSGS),部分足細胞空泡變性;電鏡下腎小毬髒層上皮細胞胞質內多數髓燐脂小體形成,腎小毬基底膜(GBM)瀰漫性變薄,厚度為(216±31)nm.傢繫調查及基因突變檢測顯示先證者女兒除有典型Fabry病腎外錶現外,亦有以血尿為主的腎髒癥狀.先證者的1箇妹妹僅錶現為鏡下血尿.先證者及其女兒α-半乳糖苷酶A(α-Gal A)活性分彆為33和75活性單位(正常參攷值為100～500活性單位),且2人均攜帶新髮現的GLA基因突變--1208ins21 bp及COL4A3基因多態性--c:3627 G＞A(p:M1209I).僅錶現為鏡下血尿的先證者的妹妹僅攜帶COL4A3基因的c:3627 G＞A(p:M1209I)多態性,α-Gal A活性正常,無GLA基因突變.結論 對于Fabry腎病患者呈現血尿,尤其是錶現為傢族性血尿時,應攷慮併認真排除併髮TBMN的可能.
목적 료해구유량충유전성질병,즉Fabry병병발박기저막신병(TBMN)적림상병리화기인돌변특점이급가계환병정황.방법 총결분석본원수치적1례41세녀성Fabrv병병발TBMN환자적림상병리특정화기인돌변정황,동시대가계성원진행조사급상관검측.결과 선증자정현전형적Fabry병적신외림상표현,포괄피진、신경통、현훈、이명、비후형심기병등,동시역유단백뇨、경하혈뇨급고혈압등신장수루표현;신활검광경하병리개변위국조성절단성신소구경화(FSGS),부분족세포공포변성;전경하신소구장층상피세포포질내다수수린지소체형성,신소구기저막(GBM)미만성변박,후도위(216±31)nm.가계조사급기인돌변검측현시선증자녀인제유전형Fabry병신외표현외,역유이혈뇨위주적신장증상.선증자적1개매매부표현위경하혈뇨.선증자급기녀인α-반유당감매A(α-Gal A)활성분별위33화75활성단위(정상삼고치위100～500활성단위),차2인균휴대신발현적GLA기인돌변--1208ins21 bp급COL4A3기인다태성--c:3627 G＞A(p:M1209I).부표현위경하혈뇨적선증자적매매부휴대COL4A3기인적c:3627 G＞A(p:M1209I)다태성,α-Gal A활성정상,무GLA기인돌변.결론 대우Fabry신병환자정현혈뇨,우기시표현위가족성혈뇨시,응고필병인진배제병발TBMN적가능.
Objective To elucidate the features of clinicopathology and mutation in Fabry disease complicated with thin basement membrane nephropathy (TBMN), and to investigate the kindred. Methods Data of clinicopathology and gene mutation of a female patient of Fabry disease complicated with TBMN admitted to the Department of Nephro]ogy in our hospital were analyzed. Members of her kindred were investigated simultaneously. Results Proband was a 41-year-old Chinese woman who presented syndrome of Fabry disease and TBMN including angiokeratomas, chronic pain, tinnitus, vertigo, left ventricular hypertrophy and nephropathy as proteinuria, microscopic hematuria and hypertension. A percutaneous renal biopsy was performed on the proband, which was consistent with FSGS and vaculization of podocytes by light microscopy.Electron microscopy showed concentric lamellated inclusions in some podocytes. Diffuse thinning of glomerular basement membrane (GBM) with a mean thickness of (216±31) nm was found. The diagnosis of TBMN with suspected Fabry disease was identified. Family screening showed that her daughter had microscopic hematuria, tinnitus and neuropathic pain. One of her sisters only had microscopic hematuria. The activity of α-galacsidase A (α-Gal A )enzyme in the proband and her daughter was 33 units and 75 units respectively (the normal range is 100 to 500 units). They all carried the novel GLA mutation 1208 ins 21 bp and COL4A3 SNP c: 3627G＞A(p:M1209I). While her sister who only had microscopic hematuria just carried the variant of COL4A3 gene-c:3627G ＞A (p:M1209I), and had the normal activity of α-Gal A with no mutation of GLA.Conclusion TBMN should be considered in the patients of Fabry disease with the condition of benign familial hematuria.
