结节性硬化症一名 10 岁女孩的临床观察

R. K. Shiralieva, U. A. Asadova
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摘要

目的。向读者介绍遗传学、分子生物学的成就,以及结节性硬化症非遗传诊断标准的发展情况,这些标准能可靠地做出正确和及时的诊断。材料与方法。本文介绍了我们对一名患有结节性硬化症的女孩 10 年观察的回顾性分析。在诊断过程中,我们使用了 Anamnestic 数据、实验室和神经影像学研究方法的结论以及 2012 年的诊断标准(TSC 临床共识会议)。结果与讨论。所进行的临床观察代表了一例结节性硬化症病例,这是一种罕见的由基因决定的噬血症,已观察了 10 年之久。该病例存在言语和精神运动发育迟缓、锥体症状和频繁的癫痫发作,有助于诊断。检测到的基因突变(TSC1 或 TSC2)和无波动的常染色体显性遗传表型可以确定诊断,但患者的母亲拒绝接受检查。因此,有必要采用另一种同样可靠的方法来确诊:根据2012年TSC临床共识会议的建议,并基于我们的患者所出现的原发性(面部血管瘤、色素减退斑、皮质结节、脑小管、脐下结节)和继发性(牙齿上有许多釉质凹陷、多发性肾囊肿)临床表现来确诊。结论。临床观察结果表明,结节性硬化症的诊断无需进行基因检测。
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Tuberous sclerosis. Clinical observation of a 10-year-old girl
Aim. Informing readers about the achievements of genetics, molecular biology, as well as the development of non-genetic diagnostic criteria for tuberous sclerosis, which reliably allow for a correct and timely diagnosis. Materials and methods. A retrospective analysis of our own 10-year observation of a girl suff ering from tuberous sclerosis is presented. Anamnestic data, conclusions of laboratory and neuroimaging methods of research, diagnostic criteria from 2012 (TSC Clinical Consensus Conference) were used to confi rm the diagnosis. Results and discussion. The clinical observation conducted represents a case of tuberous sclerosis, a rare genetically determined disease from the group of phacomatoses, observed for 10 years. The diagnosis was facilitated by the presence of speech and psychomotor development delay, pyramidal symptoms, and frequent seizures. The detected mutation in the gene (TSC1 or TSC2) with an autosomal dominant inheritance phenotype without fl uctuations would confi rm the established diagnosis, however, the patient’s mother refused examination. It was necessary to resort to another, no less reliable option to confi rm this diagnosis: the recommendations of the TSC Clinical Consensus Conference 2012 and based on the identifi ed primary (facial angiofi bromas, hypopigmented spots, cortical nodes, brain tubers, subependymal nodes) and secondary (numerous enamel pits in teeth, multiple kidney cysts) clinical signs present in our patient to establish the diagnosis. Conclusions. The presented clinical observation indicates the possibility of diagnosing tuberous sclerosis without genetic testing.
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