山东医药
山東醫藥
산동의약
SHANDONG MEDICAL JOURNAL
2014年
23期
13-15,19
,共4页
赵滢%章清萍%张晓英%包新华%吴希如
趙瀅%章清萍%張曉英%包新華%吳希如
조형%장청평%장효영%포신화%오희여
早发性癫痫脑病%ARX基因%基因突变%表型
早髮性癲癇腦病%ARX基因%基因突變%錶型
조발성전간뇌병%ARX기인%기인돌변%표형
early-onset epileptic encephalopathies%ARX gene%gene mutations%phenotype
目的:探讨早发性癫痫脑病男性患儿ARX基因突变及其临床表型特点。方法收集42例男性早发性癫痫脑病患儿详细的临床资料,采集患儿及家长外周血,应用PCR、直接测序和多重连接依赖的探针扩增( MLPA)技术对ARX基因第二外显子进行突变分析。对患儿的临床表型特点进行分析。结果42例早发性癫痫脑病患儿中3例患儿存在ARX基因第二外显子大片段缺失,检出率为7.14%(3/42)。其中1例为非特异性癫痫脑病,2例为婴儿痉挛症。3例患儿均于出生后6个月内出现难以控制的癫痫发作,2例患儿在脑电监测中发现高度失律,3例患儿对多种抗癫痫手段反应差,且均表现为严重的智力运动发育落后或倒退。未检出缺失的39例患儿发作形式呈现更多样化的特点,其中5例患儿大运动发育基本正常,3例患儿对ACTH或生酮饮食手段控制癫痫有效。结论早发性癫痫脑病患儿中部分存在ARX基因第二外显子大片段缺失。具有ARX基因突变的早发性癫痫脑病患儿,其临床表现为6个月内出现难治性癫痫发作,以部分性发作及痉挛发作为主,同时有显著的智力运动发育落后、甚至倒退;少数未检出缺失的患儿的大运动发育可基本正常,对ACTH或生酮饮食反应良好。
目的:探討早髮性癲癇腦病男性患兒ARX基因突變及其臨床錶型特點。方法收集42例男性早髮性癲癇腦病患兒詳細的臨床資料,採集患兒及傢長外週血,應用PCR、直接測序和多重連接依賴的探針擴增( MLPA)技術對ARX基因第二外顯子進行突變分析。對患兒的臨床錶型特點進行分析。結果42例早髮性癲癇腦病患兒中3例患兒存在ARX基因第二外顯子大片段缺失,檢齣率為7.14%(3/42)。其中1例為非特異性癲癇腦病,2例為嬰兒痙攣癥。3例患兒均于齣生後6箇月內齣現難以控製的癲癇髮作,2例患兒在腦電鑑測中髮現高度失律,3例患兒對多種抗癲癇手段反應差,且均錶現為嚴重的智力運動髮育落後或倒退。未檢齣缺失的39例患兒髮作形式呈現更多樣化的特點,其中5例患兒大運動髮育基本正常,3例患兒對ACTH或生酮飲食手段控製癲癇有效。結論早髮性癲癇腦病患兒中部分存在ARX基因第二外顯子大片段缺失。具有ARX基因突變的早髮性癲癇腦病患兒,其臨床錶現為6箇月內齣現難治性癲癇髮作,以部分性髮作及痙攣髮作為主,同時有顯著的智力運動髮育落後、甚至倒退;少數未檢齣缺失的患兒的大運動髮育可基本正常,對ACTH或生酮飲食反應良好。
목적:탐토조발성전간뇌병남성환인ARX기인돌변급기림상표형특점。방법수집42례남성조발성전간뇌병환인상세적림상자료,채집환인급가장외주혈,응용PCR、직접측서화다중련접의뢰적탐침확증( MLPA)기술대ARX기인제이외현자진행돌변분석。대환인적림상표형특점진행분석。결과42례조발성전간뇌병환인중3례환인존재ARX기인제이외현자대편단결실,검출솔위7.14%(3/42)。기중1례위비특이성전간뇌병,2례위영인경련증。3례환인균우출생후6개월내출현난이공제적전간발작,2례환인재뇌전감측중발현고도실률,3례환인대다충항전간수단반응차,차균표현위엄중적지력운동발육락후혹도퇴。미검출결실적39례환인발작형식정현경다양화적특점,기중5례환인대운동발육기본정상,3례환인대ACTH혹생동음식수단공제전간유효。결론조발성전간뇌병환인중부분존재ARX기인제이외현자대편단결실。구유ARX기인돌변적조발성전간뇌병환인,기림상표현위6개월내출현난치성전간발작,이부분성발작급경련발작위주,동시유현저적지력운동발육락후、심지도퇴;소수미검출결실적환인적대운동발육가기본정상,대ACTH혹생동음식반응량호。
Objective To explore the ARX gene mutation and clinical phenotypic characteristics in male patients with early-onset epileptic encephalopathy .Methods Detailed clinical information and the peripheral blood of 42 male children with early-onset epileptic encephalopathies and their parents were collected .Exon 2 of ARX gene mutation was screened u-sing PCR-DNA sequencing and multiple ligation-dependent probe amplification ( MLPA) , and the clinical phenotypic char-acteristics were also analyzed .Results Among 42 cases, large deletions of exon 2 for ARX gene can be detected in 3 ca-ses, and the overall mutation rate was 7.14%(3/42).One of the 3 patients was diagnosed as non-specific epileptic en-cephalopathies , the other two were diagnosed as infantile spasm;all 3 patients were attacked by intractable seizures occur-ring in the first six months of life .Two patients presented hypsarrhythmia in the EEG records .All 3 patients were resistant to multiple AEDs and presented severe psychomotor developmental delay or regression .Various seizure types were observed in 39 patients without large deletions of exon 2 for ARX;among them, 5 patients acquired nearly normal gross motor devel-opment, ACTH and ketogenic diet were effective for controlling seizures in 3 patients.Conclusions A part of children with early-onset epileptic encephalopathy have large deletion of exon 2 in ARX gene.Early-onset epileptic encephalopathy children with large deletion of exon 2 in ARX gene present intractable seizures during six months of life , partial seizures and spasms are the most common seizure types .Meanwhile , they are characterized by severe psychomotor developmental delay even regression .Few patients without deletions could acquire nearly normal developmental milestones and respond well to ACTH or ketogenic diet .