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Niemann-Pick Disease, Type A: Clinical Case of 5 Months Old Patient 尼曼-皮克病 A 型:5 个月大患者的临床病例
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2762
N. V. Zhurkova, N. Vashakmadze, Andrej N. Surkov, T. Turti, Kristina V. Bogdanova, Y. Kotalevskaya, E. Zakharova, L. S. Namazova-Baranova
Background. Niemann-Pick disease, type A is a rare hereditary disease from the group of lysosomal storage diseases, it is characterized by early onset and progressive course. Description of this disease’s clinical cases is crucial for early diagnosis and adequate management due to its rarity, rapid progression, and the development of new pathogenetic therapy methods.Clinical case description. The disease manifested on the second month of the patient’s life with poor weight gain, frequent pneumonia, hepatosplenomegaly, diffuse muscular hypotonia, delayed motor development, and progressive neurological symptoms. Laboratory testing has revealed significant decrease in sphingomyelinase activity in blood. The heterozygous deletion c.996del in exon 2 of the SMPD1 gene has been revealed via direct automatic sequencing; it leads to frameshifting p.F333Sfs*52 (inherited from mother). Moreover, the previously described pathogenic nucleotide variant c.1252C>T (heterozygous) has been revealed in exon 3 of the SMPD1 gene; it leads to translation arrest p.Arg418* (inherited from father). Cherry-red spots were diagnosed at fundospcopy. The diagnosis of Niemann-Pick disease, type А was established according to clinical signs and molecular genetic testing results.Conclusion. The detection of physical and motor development delay, diffuse muscular hypotonia, hepatosplenomegaly, cherry-red spots at ophthalmological examination, lung involvement, recurrent pneumonia, and progressive neurological symptoms in a child during the first months of life indicates that this patient has Niemann-Pick disease, type А. Early molecular genetic testing is crucial for timely choosing the management approach and further genetic counselling of the family.
背景介绍尼曼-皮克病 A 型是溶酶体储积病中一种罕见的遗传性疾病,具有发病早、病程进展快的特点。由于该病罕见、进展迅速,因此描述该病的临床病例对于早期诊断和适当治疗至关重要,同时也有助于开发新的病理治疗方法。该病在患者出生后的第二个月发病,表现为体重增长缓慢、肺炎频发、肝脾肿大、弥漫性肌张力低下、运动发育迟缓以及进行性神经系统症状。实验室检测发现血液中的鞘磷脂酶活性明显下降。通过直接自动测序发现,SMPD1 基因第 2 外显子中存在 c.996del 的杂合性缺失;该缺失导致 p.F333Sfs*52 的框架转换(遗传自母亲)。此外,在 SMPD1 基因的第 3 号外显子中发现了之前描述过的致病核苷酸变异 c.1252C>T(杂合子),它导致翻译停滞 p.Arg418*(遗传自父亲)。眼底检查确诊为樱桃红色斑点。根据临床症状和分子基因检测结果,确诊为А型尼曼-皮克病。儿童在出生后的头几个月内出现体格和运动发育迟缓、弥漫性肌张力低下、肝脾肿大、眼科检查发现樱桃红色斑点、肺部受累、反复肺炎和进行性神经系统症状,这表明该患者患有А型尼曼-皮克病。早期的分子遗传学检测对于及时选择治疗方法和为患者家庭提供进一步的遗传学咨询至关重要。
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引用次数: 0
Modern View on Very Early Onset and Early Onset Inflammatory Bowel Diseases in Children 儿童极早发和早发炎性肠病的现代观点
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2768
A. I. Khavkin, Anastasiya A. Permyakova, M.O. Tsepilova, A. Kaplina, S. Sitkin, Andrej N. Surkov, Stanislav D. Getmanov
Nowadays, an urgent problem of pediatric gastroenterology is the study of inflammatory bowel diseases with very early onset (VEO-IBD), which have unique genetic, clinical, immunological, morphological, and laboratory sings. Early VEO-IBD is usually considered as monogenic disease, especially in combination with congenital immune defects, which leads to difficulties in diagnosis and management this pathology. Despite this, systematization of information about this group of nosological forms of IBD is practically not carried out. This article presents a review of the available information on etiological factors, course variants, and therapeutic options for VEO-IBD.
如今,小儿胃肠病学亟待解决的问题是研究发病极早的炎症性肠病(VEO-IBD),这些疾病具有独特的遗传、临床、免疫、形态和实验室特征。早期 VEO-IBD 通常被认为是单基因疾病,尤其是合并先天性免疫缺陷时,这就给诊断和治疗带来了困难。尽管如此,有关这组 IBD 病名形式的系统化信息实际上并没有进行。本文回顾了有关 VEO-IBD 的病因、病程变异和治疗方案的现有信息。
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引用次数: 0
Ichthyosis Follicularis, Atrichia, and Photophobia (IFAP) Syndrome, Type 2: Clinical Case 毛囊性鱼鳞病、毛囊角化症和畏光症(IFAP)综合征 2 型:临床病例
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2759
E. T. Ambarchyan, Anastasia D. Kuzminova, Totuy K. Eldarova, V. V. Ivanchikov, N. V. Zhurkova, N. Vashakmadze
Background. Ichthyosis follicularis with atrichia and photophobia (IFAP syndrome), type 2 is a rare hereditary disease from the group of syndromic forms of ichthyosis. It is clinically characterized by triad of non-inflammatory follicular ichthyosis, total or subtotal alopecia at birth or shortly after, and photophobia of different severity. There is no etiotropic therapy for IFAP syndrome, while symptomatic treatment (emollients, keratolytics, retinoids) is aimed on stabilizing the patient’s condition and maintaining the optimal quality of life. About 60 cases of IFAP syndrome have been described worldwide by 2023, and none in Russia.Clinical case description. The girl, 2 years 3 months old, had signs of xeroderma, follicular hyperkeratosis, photophobia with lacrimation, and alopecia. The diagnosis of “ichthyosis follicularis with atrichia and photophobia (IFAP syndrome), type 2, autosomal dominant” was established according to anamnesis, clinical signs, and results of whole-exome sequencing, followed by validation of the identified nucleotide variant chr17:17720597G>A, p.1669C>T (p.Arg557Cys NM_001005291.2) in exon 9 of the SREBF1 gene via direct automatic sequencing in the patient and both parents (not revealed in her parents).Conclusion. Molecular genetic testing is crucial to establish IFAP syndrome as clinical signs of the disease are similar to other dermatoses. However, physicians need to have clinical suspicion when identifying cases of follicular ichthyosis in combination with alopecia and photophobia at or shortly after birth to timely diagnose IFAP syndrome and thus prevent any treatment delays.
背景。2型毛囊性鱼鳞病(Ichthyosis follicularis with atrichia and photophobia,IFAP syndrome)是一种罕见的遗传性鱼鳞病综合征。它的临床特征是非炎症性毛囊性鱼鳞病、出生时或出生后不久出现完全或次完全脱发以及不同程度的畏光。目前还没有针对鱼鳞病综合征的病因治疗方法,而对症治疗(润肤剂、角质溶解剂、维甲酸)的目的是稳定患者的病情,维持最佳的生活质量。截至 2023 年,全球约有 60 例 IFAP 综合征病例,而俄罗斯没有。这名 2 岁 3 个月大的女孩患有角化病、毛囊角化过度症、畏光伴流泪和脱发。根据病史、临床表现和全外显子组测序结果,确定了 "毛囊性鱼鳞病伴角化过度和畏光(IFAP 综合征),2 型,常染色体显性遗传 "的诊断。C>T(p.Arg557Cys NM_001005291.2)。由于该病的临床症状与其他皮肤病相似,因此分子基因检测对确定 IFAP 综合征至关重要。然而,医生在发现出生时或出生后不久即出现毛囊性鱼鳞病并伴有脱发和畏光症状的病例时,需要有临床怀疑,以便及时诊断IFAP综合征,从而避免延误治疗。
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引用次数: 0
Dynamics of Some Medical and Demographic Indicators in St. Petersburg During the Period from 2018 to 2023 2018 年至 2023 年期间圣彼得堡部分医疗和人口指标的动态变化
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2758
A. S. Simakhodsky, L. D. Sevostyanova, Yulia V. Lukashоva, Natalya V. Petrova, O. A. Simakhodsky
Background. There have been negative trends in the birth rate and population growth decline in recent years. Forecasts from demographers are also not so encouraging as the next generation of childbearing age is one from the end of the last century which is characterized by low birth rate. Population mortality exceeded the birth rate during the years of challenging and questionable economic reforms. Moreover, there was a high level of chronic morbidity in child population, and physical development had the trend to retardation. Meanwhile under these circumstances, the President of Russian Federation and the Government adopted regulatory documents (decrees, dedicated programs) that determined the directions of state social policy on improving the situation with children in Russian Federation until 2000.Objective. The aim of the study is to evaluate the dynamics of several medical and social indicators of 2018–2023 characterizing demographic trends direction, with proposals on improving medical care in the maternal and child health care system.Methods. The study has covered reporting form No. 19 of Russian Federal State Statistics Service (Rosstat) for children’s outpatient clinics, form No. 14 for children’s hospitals, form No. 030/у “Check-list of dispensary observation”. The study has used the materials of the Presidential Coordination board meeting from November 15, 2016. Statistical data was obtained from the “Office of the Federal State Statistics Service for St. Petersburg and the Leningrad Region” (Petrostat) and the Center for Analysis and Forecast of Mother and Child Health at Health Committee of St. Petersburg, Medical Information and Analytical Center (“Major results in the field of health care in St. Petersburg”, 2019, 2020, 2021, 2022). Statistical processing was carried out via variational statistics methods (Pearson’s criterion, Fisher’s angular transformation criterion) and data from the automated system of prophylactic medical examination, registration certificate FSR No. 2009/05279, corresponding to the order of the Ministry of Health of Russian Federation No. 514н dated August 10, 2017.Results. The analysis of study results confirms the negative demographic patterns in St. Petersburg like the all-Russian. Increase assisted reproductive technologies was noted alongside with birth rate decrease. There are still high rates of stillbirth and perinatal mortality, as well as increased infant mortality rate. The correlation of depopulation processes with children’s health worsening and increasing disability is emphasized.Conclusion. The problems raised in this paper do not have an straightforward solution and require multimodal approach.
背景。近年来,出生率呈下降趋势,人口增长率也在下降。人口学家的预测也不容乐观,因为下一代育龄人口是上世纪末出生率较低的一代。在经济改革充满挑战和问题的年代,人口死亡率超过了出生率。此外,儿童的慢性病发病率很高,身体发育呈迟缓趋势。在这种情况下,俄罗斯联邦总统和政府通过了一些规范性文件(法令、专项计划),确定了 2000 年前改善俄罗斯联邦儿童状况的国家社会政策方向。本研究的目的是评估 2018-2023 年若干医疗和社会指标的动态变化,以确定人口发展趋势方向,并提出改善妇幼保健系统医疗服务的建议。研究涵盖俄罗斯联邦国家统计局(Rosstat)第 19 号儿童门诊报告表、第 14 号儿童医院报告表、第 030/у 号 "医务室观察检查表"。研究使用了 2016 年 11 月 15 日总统协调委员会会议的材料。统计数据来自 "圣彼得堡和列宁格勒州联邦国家统计局办公室"(Petrostat)和圣彼得堡卫生委员会母婴健康分析与预测中心、医疗信息与分析中心("圣彼得堡医疗保健领域的主要成果",2019、2020、2021、2022年)。统计处理是通过变异统计方法(皮尔逊准则、费雪角变换准则)和预防性体检自动化系统的数据进行的,登记证书编号为FSR 2009/05279,与2017年8月10日俄罗斯联邦卫生部第514н号命令相对应。研究结果分析证实了圣彼得堡与全俄罗斯一样的负面人口模式。在出生率下降的同时,辅助生殖技术也在增加。死胎率和围产期死亡率仍然很高,婴儿死亡率也有所上升。人口减少过程与儿童健康恶化和残疾增加之间的相关性得到了强调。本文提出的问题没有直接的解决办法,需要采取多模式方法。
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引用次数: 0
General Rehabilitation Principles for Patients with Cerebral Palsy After Single-Event Multilevel Surgery (SEMLS) 单次多平面手术 (SEMLS) 后脑瘫患者的一般康复原则
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2763
O. Klochkova, D. A. Popkov, A. Mamedyarov, U. F. Mamedov
Single-Event Multilevel Surgery (SEMLS) is the standard for surgical correction of secondary orthopedic deformities in cerebral palsy (CP). SEMLS include simultaneous correction of soft tissue contractures, bone deformities, incomplete and complete joint dislocation to improve the gait and functional activity of patients with CP. The surgery volume determines the need for planned and long-term postoperative rehabilitation, however, there are no confirmed guidelines, neither Russian, nor foreign, on the patient’s management during postoperative period. This review provides an analysis of rehabilitation approaches after SEMLS at CP, offers recommendations on preparation and step-by-step postoperative restoration of motor function, and prevention of any associated complications.
单次多平面手术(SEMLS)是脑瘫(CP)继发性矫形的手术矫正标准。SEMLS 包括同时矫正软组织挛缩、骨骼畸形、不完全和完全关节脱位,以改善 CP 患者的步态和功能活动。手术量决定了术后长期康复计划的必要性,然而,无论是俄罗斯还是国外,都没有关于术后患者管理的确切指南。本综述分析了 CP SEMLS 术后的康复方法,就术后运动功能的准备和逐步恢复以及相关并发症的预防提出了建议。
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引用次数: 0
Sodium-Dependent Glucose Transporter Type 2 Inhibitors as a Breakthrough in Neutropenia and Neutrophil Dysfunction Management in Patients with Glycogen Storage Disease Type Ib 钠依赖性葡萄糖转运体 2 型抑制剂是治疗 Ib 型糖原贮积症患者中性粒细胞减少症和中性粒细胞功能障碍的突破口
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2761
Andrej N. Surkov, L. S. Namazova-Baranova, Anna L. Arakelyan, E. E. Bessonov, N. V. Zhurkova
Glycogen storage disease type Ib (GSD Ib) is a rare and extremely severe disease included in the group of hereditary carbohydrate metabolism disorders. The condition is caused by pathogenic variants in the SLC37A4 gene leading to glucose metabolic disorder in the liver and kidneys, and as a result to severe organomegaly, hypoglycemia, and metabolic decompensation. Moreover, neutropenia and neutrophil dysfunction are noted in patients with GSD Ib. The use of granulocyte colony stimulating factor only increases the number of dysfunctional neutrophils without affecting their functional activity, what determines the inefficacy of such treatment. In recent years, the mechanism of neutropenia in GSD Ib has been clarified, so new therapeutic agents for its relief have been created. This article presents the overview of data on the successful results of renal sodium-glucose cotransporter type 2 inhibitors (gliflozins) usage in patients with GSD Ib.
糖原贮积病 Ib 型(GSD Ib)是一种罕见的极其严重的疾病,属于遗传性碳水化合物代谢紊乱病。这种疾病是由 SLC37A4 基因的致病变异引起的,会导致肝脏和肾脏的葡萄糖代谢紊乱,从而导致严重的器官肿大、低血糖和代谢失调。此外,GSD Ib 患者还会出现中性粒细胞减少和中性粒细胞功能障碍。使用粒细胞集落刺激因子只能增加功能障碍中性粒细胞的数量,而不会影响其功能活性,这就决定了这种治疗方法的无效性。近年来,GSD Ib 中性粒细胞减少症的发病机制已被阐明,因此用于缓解该症状的新治疗药物应运而生。本文概述了肾钠-葡萄糖共转运体2型抑制剂(格列酮类)在GSD Ib患者中的成功应用。
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引用次数: 0
Lung Volume and Pneumatization Changes in Children in Early Post-Surgical Period After Correction of Severe Neuromuscular Scoliosis Complicated with Respiratory Failure: Cohort Study 严重神经肌肉性脊柱侧凸并发呼吸衰竭矫正术后早期儿童的肺容量和气化变化:队列研究
Pub Date : 2024-07-12 DOI: 10.15690/vsp.v23i3.2766
Anna V. Makarova, Mudhar A.А. Alshaowa, Оlga S. Maslak, А. Y. Mushkin
Background. The effect of spinal deformity surgical correction in children with severe neuromuscular scoliosis (NMS) on lung function remains unexplored.Objective. The aim of the study is to — to survey the dynamics of volume and structure of lungs pneumatization in children after surgical correction of severe neuromuscular deformities of the spine complicated by respiratory disorders.Methods. CT scans of lungs from 5 children with right-sided NMS, grade IV (Cobb angle < 50°) and functional respiratory disorders (lung capacity < 30% of normal value according to spirometry data and/or clinical signs of respiratory failure) were retrospectively studied. Right and left lungs volumes, their ratio (asymmetry index), indicators of distribution of tissue density of each lung (as a percentage of total volume) before (not earlier than 2 months) and after (not later than 3 months) surgical correction of scoliosis were determined via the data processing from CT scans of the thoracic spine.Results. All children had both lung volumes below reference values (healthy peers) before surgery. The right lung volume increased by 11% (6.4–40.6%), the left lung — by 41% (22.5–90%) with the asymmetry index approaching the reference values for the corresponding age after correction of spinal deformity (the value of scoliotic deformity decreased (median) from 94 to 68°). The volume of normal ventilation zones increased from 30 to 50% on the right side, and from 41 to 55% on the left side, primarily due to decrease in the volume of hypoventilation zones, but not atelectasis and emphysema.Conclusion. Surgical correction of spinal deformity in children with NMS, grade IV, complicated with respiratory failure led to normalization of lungs volume and tissue density characteristics already in the early postoperative period.
背景。严重神经肌肉性脊柱侧弯症(NMS)儿童脊柱畸形手术矫正对肺功能的影响仍未得到研究。本研究的目的是调查脊柱严重神经肌肉畸形并发呼吸障碍手术矫正后儿童肺部气化的体积和结构动态。回顾性研究了 5 名右侧 NMS、IV 级(Cobb 角小于 50°)和功能性呼吸障碍(根据肺活量数据和/或呼吸衰竭的临床表现,肺活量小于正常值的 30%)患儿的肺部 CT 扫描结果。通过对胸椎 CT 扫描数据的处理,确定了脊柱侧凸手术矫正前(不早于 2 个月)和矫正后(不晚于 3 个月)的左右肺容积、其比例(不对称指数)、各肺组织密度分布指标(占总容积的百分比)。手术前,所有患儿的双肺体积均低于参考值(健康同龄人)。脊柱畸形矫正后,右肺容积增加了11%(6.4-40.6%),左肺容积增加了41%(22.5-90%),不对称指数接近相应年龄的参考值(脊柱侧弯畸形值(中位数)从94°下降到68°)。右侧正常通气区的容积从30%增加到50%,左侧从41%增加到55%,这主要是由于通气不足区的容积减少,而不是由于肺不张和肺气肿。结论:对并发呼吸衰竭的IV级NMS患儿进行脊柱畸形手术矫正,可在术后早期使肺容量和组织密度特征恢复正常。
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引用次数: 0
Speech and Language Assessment Tools for Preschool and Primary School Children: Literature Review 学前和小学儿童的言语和语言评估工具:文献综述
Pub Date : 2024-07-11 DOI: 10.15690/vsp.v23i3.2752
Valeriya P. Lelik, Maria D. Dyachkova, S. Dorofeeva
The wide range of methods has been suggested for assessing the speech and language development in children. Therefore, the choice of suitable assessment tool is not always trivial. This article provides the overview of the methods used to examine Russian-speaking children, emphasises the parameters crucial for their comparison and, finally, choice itself. This review can be useful for researchers in the field of children’s speech and language development, specialists using various tools for assessing children’s speech in practice (pediatricians, speech pathologists, defectologists), as well as teachers and parents.
评估儿童言语和语言发展的方法多种多样。因此,选择合适的评估工具并非易事。本文概述了用于检查俄语儿童的方法,强调了比较这些方法的关键参数,最后介绍了选择方法本身。这篇综述对儿童言语和语言发展领域的研究人员、在实践中使用各种工具评估儿童言语的专家(儿科医生、言语病理学家、缺陷学家)以及教师和家长都有帮助。
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引用次数: 0
Progeroid Cockayne Syndrome 类早衰科凯恩综合征
Pub Date : 2024-07-10 DOI: 10.15690/vsp.v23i3.2767
Anastasiya L. Kungurtseva, A. Vitebskaya
Cockayne syndrome is a rare genetic disease from the group of premature aging syndromes associated with impaired DNA repair. The syndrome is autosomal recessive, and it is caused by pathogenic variants in ERCC8, ERCC6, XPB (ERCC3), XPD (ERCC2), and XPG (ERCC5) genes. Its prevalence is 1 case per 2.5 million people. The clinical signs include nervous, cardiovascular and musculoskeletal systems impairments, severe growth retardation, and body weight deficiency. The average life expectancy of these patients varies from 5 to 30 years and depends on the disease type and severity. There is no pathogenetic treatment. This article presents the results of the latest research on the disease diagnosis and management.
科克恩综合征是一种罕见的遗传病,属于与 DNA 修复功能受损有关的早衰综合征。该综合征为常染色体隐性遗传,由 ERCC8、ERCC6、XPB(ERCC3)、XPD(ERCC2)和 XPG(ERCC5)基因的致病变体引起。其发病率为每 250 万人中有 1 例。临床表现包括神经、心血管和肌肉骨骼系统受损、严重发育迟缓和体重不足。这些患者的平均寿命从 5 岁到 30 岁不等,取决于疾病的类型和严重程度。目前尚无病理治疗方法。本文介绍了有关该疾病诊断和治疗的最新研究成果。
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引用次数: 0
Wilson’s Disease Caused by Previously Undescribed Homozygous Nucleotide Variant of the ATP7B Gene: Clinical Cases 以前未曾描述过的 ATP7B 基因同位核苷酸变异引起的威尔森氏病:临床病例
Pub Date : 2024-05-05 DOI: 10.15690/vsp.v23i2.2725
D. Chernevskiy, A. E. Lavrova, E. Konovalova, Elena Yu. Borisova, N. A. Doroshchuk, O. Groznova
Wilson’s disease is severe autosomal recessive disease manifested primarily by hepatic, neurological, and psychiatric disorders due to excessive copper deposition in organs and tissues. Clinical case description. The variant with uncertain clinical value of the ATP7B gene, c.2111C>T (p.T704I, chr13:52534294G>A (HG19)), was described in the family where parents are cousins. The eldest daughter out of four children died at the age of 11 due to liver cirrhosis. Wilson’s disease was genetically confirmed in two children (clinically — abdominal form). The younger son was diagnosed heterozygous state of the disease (without any clinical manifestations). The revealed variant of the ATP7B gene was previously identified in 3 more patients with Wilson’s disease, however, in a compound heterozygous state with known pathogenic genetic variant. Conclusion. c.2111C>T (p.T704I) variant of the ATP7B gene can be considered as probably pathogenic. Further research is required to evaluate its functional significance in Wilson’s disease pathogenesis.
威尔逊氏病是一种严重的常染色体隐性遗传病,主要表现为肝脏、神经和精神疾病,这是因为铜在器官和组织中沉积过多。临床病例描述。在一个父母为表亲的家庭中,ATP7B 基因的 c.2111C>T (p.T704I, chr13:52534294G>A (HG19))变异具有不确定的临床价值。四个孩子中的长女在 11 岁时死于肝硬化。威尔逊氏病在两个孩子身上得到了遗传学证实(临床表现为腹型)。小儿子被诊断为杂合型疾病(无任何临床表现)。所发现的 ATP7B 基因变异先前也在另外 3 名威尔逊氏病患者身上发现过,但都是在已知致病基因变异的复合杂合状态下发现的。结论:ATP7B 基因的 c.2111C>T (p.T704I) 变异可能是致病的。需要进一步研究评估其在威尔逊氏病发病机制中的功能意义。
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引用次数: 0
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Current pediatrics
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