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中华医学遗传学杂志
四川大学
中华医学遗传学杂志

四川大学

张思仲

双月刊

1003-9406

cjmg@cma.org.cn

028-85501165

610041

四川省成都市人民南路三段17号(四川大学华西校区)

中华医学遗传学杂志/Journal Chinese Journal of Medical GeneticsCSCD北大核心CSTPCD
查看更多>>中华医学会主办，四川大学承办。本刊以报道我国医学遗传学、人类遗传学和相关领域的基础理论、技术方法等最新研究成果；以从事医学遗传学工作的各科临床医生、计划生育工作者、大专院校和科研单位有关人员为主要读者对象。设有述评、论著、技术与方法、综述、调查报告、遗传咨询、临床细胞遗传学、病例报告等栏目。 从1998年以来被美国《医学索引》（IM）、《化学文摘》（CA）、《工程索引》（EI）、ISI数据库的Biological Abstracts及BIOSIS Previews，波兰《哥白尼索引》（IC）,荷兰《医学文摘》（EM）和俄罗斯《文摘杂志》（AJ）等国际著名检索系统收录。
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    应用荧光原位杂交技术验证骨髓增生异常综合征的非克隆性染色体异常

    王峥王燕琳宋文杰冯麟...
    257-262页
    查看更多>>摘要：目的 探讨应用荧光原位杂交(FISH)技术验证骨髓增生异常综合征(MDS)经传统染色体显带分析(CBA)检测到的非克隆性染色体异常(n-CCA)的价值。 方法 回顾性分析2011年10月至2020年12月北京大学人民医院CBA检测具有n-CCA的91例MDS患者的临床资料及染色体核型和FISH检测结果。 结果 在91例患者中，CBA共检测到94例次非克隆性+8、5q-、-7、7q-和20q-异常，其中43例次(45.7%)经FISH验证为阳性，+8、5q-、-7、7q-和20q-的验证率分别为47.6%(30/63)、25%(2/8)、41.7%(5/12)、40%(2/5)和66.7%(4/6)，FISH阳性的细胞占比为4% ~ 90%(中位7%)。将91例患者按CBA分析的中期分裂相数目分为3组，即≥ 20、10 ~ <20、< 10。3组的FISH验证率分别为43.7%(31/71)、33.3%(3/9)、63.6%(7/11)，未见明显差异( P>0.05)。对26例仅接受支持治疗的患者进行连续监测，结果显示91.7%(11/12)经FISH验证的异常持续存在，而92.9%(13/14)FISH验证为阴性的n-CCA属于一过性异常。 结论 约半数CBA检测到的n-CCA经FISH证实为克隆性异常，FISH验证的阳性率与CBA的中期分裂相数目无关。对于CBA检测出的n-CCA，建议通过FISH检测验证其克隆性并进行连续追踪观察。 Objective To assess the value of fluorescence in situ hybridization (FISH) technique for the verification of the clonalities of non-clonal cytogenetic abnormalities (n-CCA) identified by conventional chromosome banding analysis (CBA) in patients with Myelodysplastic syndrome (MDS). Methods Clinical data and results of karyotyping and FISH assays for 91 patients of MDS with n-CCA identified by CBA were retrospectively analyzed. Results In total 94 non-clonal + 8, 5q-, -7, 7q- or 20q- were detected by CBA, among which 43 (45.7%) were verified to be clonal abnormalities by FISH. The detection rates for + 8, 5q-, -7, 7q- and 20q- by FISH were 47.6% (30/63), 25% (2/8), 41.7% (5/12), 40% (2/5) and 66.7% (4/6), respectively, with the positive cells accounting for 4% to 90% of all counted cells, with a median value of 7%. The 91 patients were divided into three groups including ≥ 20, 10 ~ <20 and < 10 based on the numbers of metaphase cells in CBA, and the detection rates by FISH for the three groups were 43.7% (31/71), 33.3% (3/9) and 63.6% (7/11), respectively, which showed no statistically difference ( P >0.05). Continuous CBA and FISH surveys were conducted for 26 patients who received supportive treatment, and the results revealed that 91.7% (11/12) of FISH-verified positive abnormalities had persisted, whereas 92.9% (13/14) of the n-CCA verified as negative by FISH was transient. Conclusion Nearly half of the CBA identified n-CCA have been verified as clonal aberrations by FISH, and the FISH detection rate showed no correlation with the number of metaphase cells. FISH test is strongly recommended for verifying the clonalities of n-CCA detected by CBA, and continuous cytogenetic survey of the patients with MDS is necessary.

    骨髓增生异常综合征克隆染色体异常荧光原位杂交

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    华氏巨球蛋白血症患者44例免疫球蛋白重链序列使用特征的分析

    汤菁夏奕尹华王莉...
    263-268页
    查看更多>>摘要：目的 探讨免疫球蛋白重链可变区(IGHV)基因的变异状态与华氏巨球蛋白血症(WM)患者预后的相关性。 方法 采集2010年12月至2020年12月在江苏省人民医院初诊的44例WM患者的血液和/或骨髓样本，通过直接测序确定主克隆并进行免疫球蛋白重链(IGH)基因的序列分析，描述WM患者IGHV-IGHD-IGHJ基因的使用特征。 结果 在44例患者中，IGHV3基因家族的使用率最高，该结果与中国医学科学院血液病研究所的数据相似，主要使用的片段为IGHV3-23(20.45% vs. 15.44%)及IGHV3-74(11.36% vs. 7.35%)，其次为IGHV4基因家族(15.91% vs. 24.26%)。但使用IGHV4家族与预后无相关性。以98%作为IGHV变异状态的截断值，仅5例患者IGHV无变异，且与预后无相关性。根据X-tile分析，选择将92.6%作为WM患者IGHV变异状态的截断值，26例(59.1%)IGHV无变异患者的血清乳酸脱氢酶增高(P<0.05)，无进展生存期(P<0.05)及OS(P<0.05)与IGHV变异组相比均显著缩短。 结论 患者IGHV-IGHD-IGHJ的使用特征与中国医学科学院血液病研究所的数据相似，但使用IGHV4家族与预后无相关性。此外，98%可能并不适用于区分WM患者的IGHV变异状态。 Objective To analyze the correlation between the mutational status of immunoglobulin heavy chain variable (IGHV) gene with the prognosis of patients with Waldenström macroglobulinemia (WM). Methods Immunoglobulin heavy chain gene (IGH) clonotypic sequence analysis was carried out to assess the mutational status of IGHV in the blood and/or bone marrow samples from 44 WM patients. The usage characteristics of IGHV-IGHD-IGHJ gene was explored. Results The most common IGHV subgroup was IGHV3, which was similar to the data from the Institute of Hematology of chinese Academy of Medical Science. IGHV3-23 (20.45% vs. 15.44%) and IGHV3-74 (11.36% vs. 7.35%) were the main fragments used, which was followed by IGHV4 gene family (15.91% vs. 24.26%). However, no significant correlation was found between the IGHV4 usage and the prognosis of the patients. Should 98% be taken as the cut-off value for the IGHV mutation status, only 5 patients had no IGHV variant, and there was no correlation with the prognosis. Based on the X-tile analysis, 92.6% was re-selected as the cut-off value for the IGHV variant status in such patients. LDH was increased in 26 patients (59.1%) without IGHV variant (P<0.05), progression-free survival (P<0.05) and overall survival (P<0.05) were significantly shorter compared with those withIGHV variants. Conclusion The usage characteristics of IGHV-IGHD-IGHJ in our patients was similar to reported by the Institute of Hematology of chinese Academy of Medical Science, albeit that no correlation was found between the IGHV4 usage and the prognosis of the patients. Furthermore, 98% may not be appropriate for distinguishing the IGHV variant status in WM patients.

    免疫球蛋白重链可变区基因变异华氏巨球蛋白血症预后

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    遗传性球形红细胞增多症患儿16例的 SPTB基因变异特征分析

    葛洋洋李娟娟韩烨谢华...
    269-275页
    查看更多>>摘要：目的 分析16例SPTB基因变异所致遗传性球形红细胞增多症(HS)患儿的临床特征和变异谱，探讨变异类型与HS临床表型的相关性。 方法 选择2018年11月至2022年7月就诊于首都儿科研究所附属儿童医院血液科门诊的HS患儿为研究对象。收集患儿的临床资料，采用全外显子组测序对患儿进行检测，对候选变异进行Sanger测序家系验证，同时进行生物信息学分析和蛋白三维结构预测。采用χ2检验比较具有不同蛋白质功能结构域的SPTB基因变异位点的患儿的临床表型差异。 结果 16例HS患儿的男、女比例为6：10，中位发病年龄为7岁10个月，主要临床表现为贫血、黄疸、网状红细胞增多，其中轻、中、重度贫血占比分别为56.25%(9/16)、31.25%(5/16)、12.50%(2/16)。基因检测结果显示，16例HS患儿均携带SPTB基因变异，其中10种变异既往未见报道，7例患儿的变异为新发。生物信息学分析显示，16例HS患儿中SPTB基因功能丧失型变异(LOF)占93.75%(15/16)，错义变异占6.25%(1/16)；变异位点分别位于收缩蛋白部分重复结构域(68.75%，11/16)、肌动蛋白结合域CH1(25.00%，4/16)和二聚化结构域(6.25%，1/16)。χ2检验显示，变异位点位于不同功能结构域的患儿的贫血程度差异无统计学意义(χ2 ＝ 3.345，P>0.05)。蛋白三维结构预测结果显示，c.253G>A(p.G85R)错义变异可能影响蛋白质的正确折叠和二聚化的氢键网络，导致蛋白结构的异常；其余15种LOF变异可产生相应的截短蛋白，影响收缩蛋白的功能。根据美国医学遗传学与基因组学学会相关指南，上述变异均被评判为致病或可能致病。 结论 16例携带SPTB基因变异的HS患儿中轻中度贫血占比较高，变异类型以LOF为主，不同功能结构域的变异并不影响HS患儿的临床表现。本研究丰富了SPTB基因的致病变异谱和临床表型谱。 Objective To analyze the clinical characteristics and spectrum of SPTB gene variants among 16 Chinese children with Hereditary spherocytosis (HS) and explore their genotype-phenotype correlation. Methods Sixteen children who were diagnosed with HS at the Affiliated Hospital of Capital Institute of Pediatrics from November 2018 to July 2022 were selected as the research subjects. Genetic testing was carried out by whole exome sequencing. Candidate variants were verified by Sanger sequencing and subjected to bioinformatic analysis and prediction of 3D structure of the protein. Correlation between the SPTB genotypes and clinical phenotypes was analyzed using Chi-squared test. Results The male-to-female ratio of the HS patients was 6 : 10, with the median age being 7-year-and-10-month. Clinical features of the patients have included anemia, reticulocytosis and gradual onset of splenomegaly. Mild, moderate and severe anemia have respectively occurred in 56.25% (9/16), 31.25% (5/16) and 12.50% (2/16) of the patients. SPTB gene variants were detected in all patients, among which 10 were unreported previously and 7 were de novo in origin. Loss of function (LOF) variants accounted for 93.75% (15/16). Only one missense variant was detected. Eleven, 4 and 1 of the variants had occurred in the repeat domain, CH1 domain, and dimerization domain, respectively. There was no significant correlation between the type or domain of the SPTB gene variants with the clinical features such as severity of anemia (χ2 = 3.345, P>0.05). All of the variants were predicted to be pathogenic or likely pathogenic based on the guidelines from the American College of Medical Genetics and Genomics. Conclusion Mild to moderate anemia are predominant clinical features of the HS children harboring a SPTB gene variant, for which LOF variants are the main mutational type. The clinical feature of HS is unaffected by the type of the variants. Above finding has enriched the spectrum of SPTB gene variants and its clinical phenotypes.

    儿童遗传性球形红细胞增多症SPTB基因

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    错义变异所致遗传性低纤维蛋白原血症家系的遗传学分析

    郑晓勇陈怡温梦珍金艳慧...
    276-281页
    查看更多>>摘要：目的 回顾性分析2个新的杂合错义变异所致遗传性低纤维蛋白原血症(IFD)家系的表型和基因变异，并探讨其分子发病机制。 方法 选取2个分别于2021年3月30日和2021年5月27日就诊于温州医科大学附属第一医院的IFD先证者及其家系成员作为研究对象。收集临床资料，并检测先证者及其家系成员的凝血指标，用Sanger测序法分析先证者FGA、FGB及FGG基因的变异位点。利用生物信息学软件分析候选变异位点的保守性并预测变异蛋白的致病性，同时模拟变异前后蛋白质结构及分子间作用力的变化。 结果 先证者1为18岁男性，血浆纤维蛋白原活性(Fg：C)和血浆纤维蛋白原抗原(Fg：Ag)均明显偏低，分别为0.80 g/L和1.00 g/L。先证者2为43岁男性，其Fg：C和Fg：Ag分别为1.35 g/L和1.30 g/L，均偏低；先证者1的父亲、先证者2的父亲及儿子的Fg：C和Fg：Ag均偏低。测序结果发现先证者1及其父亲FGG基因的第7外显子均存在c.688T>G(p.Phe230Val)杂合错义变异；先证者2及其父亲和儿子FGA基因的第6外显子均存在c.2516A>C(p.Asn839Thr)杂合错义变异。同源性分析表明Phe230和Asn839残基在进化上高度保守。生物信息学软件预测提示p.Phe230Val和p.Asn839Thr变异均为致病性；蛋白模拟模型结果显示p.Asn839Thr变异使氨基酸之间的氢键发生改变，从而影响蛋白空间结构的稳定性。 结论 p.Phe230Val和p.Asn839Thr杂合错义变异可能是这2个家系发生IFD的原因。 Objective To retrospectively analyze the clinical phenotypes and genetic variants in two Chinese pedigrees affected with Hereditary hypofibrinemia (IFD) and explore their molecular pathogenesis. Methods Two probands and their pedigree members were admitted to the First Affiliated Hospital of Wenzhou Medical University on March 30, 2021 and May 27, 2021, respectively. Clinical phenotypes of the probands were collected, and blood clotting indexes of the probands and their pedigree members were determined. Variants of the FGA, FGB and FGG genes were analyzed by Sanger sequencing, and candidate variants were verified by sequence comparison. Bioinformatic software was used to analyze the conservation of the amino acids and pathogenicity of the proteins. Alteration in protein structure and intermolecular force before and after the variant was analyzed by simulating the protein model. Results Proband 1, a 18-years-old male, had significantly low plasma fibrinogen activity (Fg: C) and plasma fibrinogen antigen (Fg: Ag), respectively at 0.80 g/L and 1.00 g/L. Proband 2, a 43-year-old male, had slightly low Fg: C and Fg: Ag at 1.35 g/L and 1.30 g/L, respectively. The Fg: C and Fg: Ag of proband 1′s father, proband 2′s father and son were also below the normal level. Genetic testing showed that proband 1 had harbored a heterozygous missense variant of c. 688T>G (p.Phe230Val) in exon 7 of theFGG gene, which was inherited from his father. Proband 2, his father and son all had harbored a heterozygous variant of c. 2516A>C (p.Asn839Thr) in exon 6 of theFGA gene. Homology analysis showed that the Phe230 and Asn839 residues were highly conserved among homologous species. Bioinformatic analysis predicted that both p. Phe230Val and p.Asn839Thr were pathogenic variants. Analysis of protein simulation model showed that the p. Asn839Thr variant has changed the hydrogen bond between the amino acids, thus affecting the stability of the protein structure. Conclusion The heterozygous missense variants of p. Phe230Val and p. Asn839Thr probably underlay the IFD in the two pedigrees.

    纤维蛋白原缺乏血症纤维蛋白原基因变异蛋白预测模型家系

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    家族性噬血细胞性淋巴组织细胞增生症患者1例的基因变异分析

    张在卉余秀蓉王志红李岭...
    282-286页
    查看更多>>摘要：目的 探讨1例家族性噬血细胞性淋巴组织细胞增生症(FHL)患者的遗传学病因，并对其家系成员进行基因变异分析。 方法 选取2021年8月3日因"发热7+h"就诊于厦门大学附属东方医院(联勤保障部队第九〇〇医院)的1例家族性FHL男性患者(出生35日)作为研究对象。应用全外显子组测序(WES)技术对先证者及其父母进行致病变异筛查。根据先证者的临床表型，确定候选变异，并通过Sanger测序进行验证。 结果 WES结果显示先证者存在PRF1：c.67_71delinsGCCC及c．65delC变异，Sanger测序证实二者分别遗传自其母亲和父亲。其中c.67_71delinsGCCC为未见报道的新变异。根据美国医学遗传学与基因组学学会相关指南判定为致病性变异(PVS1+PM2_Supporting+PM3+PP4)，c.65delC为已知的致病变异(PVS1+PM2_Supporting +PM3_Strong+PP4)。 结论 PRF1基因c.67_71delinsGCCC及c.65delC复合杂合变异可能是该噬血细胞性淋巴组织细胞增生症患者的遗传学病因。新变异的检出拓展了PRF1基因的变异谱。 Objective To explore the genetic basis for a patient with Familial hemophagocytic lymphohistiocytosis(FHL). Methods A 35-day-old male infant who was admitted to the Oriental Hospital Affiliated to Xiamen University on August 3, 2021 due to fever for over 7 hours was selected as the study subject. Whole exome sequencing (WES) was carried out for the proband and his parents, and candidate variants were selected based on the clinical phenotypes of the proband and confirmed by Sanger sequencing. Results WES and Sanger sequencing results revealed that the proband had harbored compound heterozygous variants c. 67_71delinsGCCC and c. 65delC of the PRF1 gene, which were respectively inherited from his mother and father. The c. 67_71delinsGCCC variant was unreported previously. Based on the guidelines of American College of Medical Genetics and Genomics and clinical manifestations, it was classified as pathogenic (PVS1+ PM2_Supporting+ PM3+ PP4). c. 65delC was a known pathogenic variant (PVS1+ PM2_Supporting + PM3_Strong+ PP4). Conclusion The compound heterozygous variants of c.67_71delinsGCCC and c. 65delC of the PRF1 gene probably underlay the disease in the proband. The identification of the novel variant has expanded the mutational spectrum of the PRF1 gene.

    家族性噬血细胞性淋巴组织细胞增生症PRF1基因全外显子组测序Sanger测序

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    血红蛋白Santa Ana患儿1例的遗传学分析

    刘江华于洁许芯李岭...
    287-290页
    查看更多>>摘要：目的 对1例血红蛋白Santa Ana (Hb Santa Ana)患儿进行遗传学分析，明确其致病原因。 方法 选择2013年8月4日因"发现贫血、脾大伴尿色加深5年"于重庆医科大学附属儿童医院就诊的一例Hb Santa Ana患儿为研究对象，并收集其临床资料。采集患儿及其父母的外周血样，进行血常规检查。采用全自动血细胞分析仪检测患儿及其父母的红细胞参数，利用高效液相色谱分析(HPLC)技术检测患儿及其父母的血红蛋白组分，利用跨越断裂点PCR及PCR-反向斑点杂交技术检测患儿的常见地中海贫血基因突变，利用二代测序(NGS)检测患儿的珠蛋白基因变异，并通过Sanger测序对候选变异进行验证。 结果 患儿表现为轻中度溶血性贫血，血常规提示血红蛋白含量(90 g/L)和红细胞平均血红蛋白浓度(267 g/L)均偏低，网织红细胞比值(0.141)偏高，提示为低色素性增生性贫血。血红蛋白组分分析提示患儿血红蛋白F升高至10.7%，提示β珠蛋白肽链合成存在异常。患儿HPLC分析图谱可见异常峰，面积占总面积的4.5%。患儿父母的血常规和血红蛋白组分分析结果均未见异常。未在患儿中检出中国人常见的地中海贫血基因变异，珠蛋白基因测序结果提示患儿存在HBB：c.266T>C杂合变异，其父母未见相同的变异。依据美国医学遗传学与基因组学学会相关指南判定为致病变异。 结论 患儿存在HBB：c.266T>C杂合变异，以溶血性贫血为主要临床表征，可确诊为Hb Santa Ana。 Objective To explore the genetic basis for a child with Hemoglobin Santa Ana (Hb Santa Ana). Methods The child was admitted to the Children′s Hospital of Chongqing Medical University on August 4, 2013 due to anemia, splenomegaly and deepening urine color for 5 years. His clinical data were collected. Peripheral blood samples of the child and his parents were collected for routine blood test. The erythrocyte parameters of the child and his parents were detected with an automatic hemocyte analyzer. The hemoglobin components of the child and his parents were detected by high-performance liquid chromatography (HPLC). Common mutations associated with thalassemia were detected by Gap-PCR and PCR-reverse dot blotting (PCR-RDB). Rare variants of the globin genes were detected by next generation sequencing (NGS), and the result was verified by Sanger sequencing. Results The child has shown mild to moderate hemolytic anemia. Routine blood test showed that he had lower hemoglobin (90 g/L) and mean corpuscular hemoglobin concentration (267 g/L) but a higher reticulocyte ratio (0.141), which indicated hyperplastic hypochromic anemia. Analysis of hemoglobin component showed that his hemoglobin F was elevated to 10.7%, which indicated abnormal synthesis of β globin peptide chain. HPLC analysis showed an abnormal peak accounting for 4.5% of the total area. Neither of his parents was found to have abnormal results by routine blood test and hemoglobin component analysis. No common globin gene variant was detected in the child. Gene sequencing revealed that the child has harbored a heterozygous variant of HBB: c. 266T>C, which wasde novo in origin. Based on the guidelines of American College of Medical Genetics and Genomics, the variant was predicted to be pathogenic. Conclusion The heterozygous HBB: c. 266T>C variant probably underlay the hemolytic anemia associated with Hb Santa Ana in this patient.

    血红蛋白SantaAna珠蛋白基因溶血性贫血基因变异儿童

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    p表型个体的血清学特点和分子机制研究1例

    屠佳燕周建华吴瑾惠洪小珍...
    291-294页
    查看更多>>摘要：目的 分析1例p表型个体的血清学特征和分子机制。 方法 选取2021年5月在嘉兴市中心血站进行血型鉴定的1例p表型个体为研究对象。用血型血清学方法鉴定其ABO、RhD、P1PK血型和意外抗体。采用PCR-直接测序法(PCR-SBT)对编码P1和PK抗原的α1，4-半乳糖基转移酶基因(A4GALT)的编码区进行测序分析。 结果 该个体的血型为A型、RhD阳性、P1PK系统为罕见的p表型，血清中存在抗-PP1Pk。测序结果显示其A4GALT基因编码区存在c.343A>T纯合变异。 结论 A4GALT基因c.343A>T纯合变异很可能导致了p表型个体。 Objective To analyze the serological characteristics and molecular mechanism for an individual with p phenotype. Methods An individual with p phenotype upon blood group identification at Jiaxing Blood Center in May 2021 was analyzed. ABO, RhD and P1PK blood groups and irregular antibodies in her serum were identified using conventional serological methods. The encoding region of α1, 4-galactosyltransferase gene ( A4GALT) encoding P1 and Pk antigens was analyzed by polymerase chain reaction-sequence-based typing (PCR-SBT). Results The individual was A group, RhD positive and had a p phenotype of the P1PK blood group system. Anti-PP1Pk was discovered in her serum. Sequencing analysis revealed that she has harbored a homozygous c. 343A>T variant of theA4GALT gene. Conclusion The homozygous c. 343A>T variant of theA4GALT gene probably underlay the p phenotype in this individual.

    P1PK血型系统p表型抗-PP1PkA4GALT基因

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    浙江嘉兴地区地中海贫血基因突变的携带者筛查及产前诊断

    姜湖铃周赤燕杨莉李素萍...
    295-300页
    查看更多>>摘要：目的 分析浙江嘉兴地区人群地中海贫血(地贫)的分子流行病学数据，为产前诊断、遗传咨询和出生缺陷防控提供科学依据。 方法 选取2017年4月至2021年9月就诊于嘉兴市妇幼保健院的24 003例孕妇作为研究对象，采用毛细管血红蛋白电泳联合血常规检测进行地贫初筛，对初筛阳性者进一步进行地贫基因荧光定量PCR检测，并为具有生育中间型或重型地贫患儿风险的家庭提供产前诊断。 结果 在24 003例孕妇中，1 211例地贫初筛呈阳性，443例确诊为地贫突变携带，总检出率为36.58%(443/1 211)。在443例地贫突变携带者中，α-地贫、β-地贫和α-复合β-地贫突变携带者的占比分别为27.31%(121/443)、70.65%(313/443)和2.04%(9/443)。1个双方携带家系的胎儿产前诊断结果为--SEA/αCSα，预测其临床表型为中间型或重型地贫，建议终止妊娠。 结论 浙江嘉兴地区可将孕期血红蛋白电泳联合血常规检测作为地贫初筛的指标，结合进一步的地贫基因检测，对本地区的地贫防控具有重要的价值。 Objective To study the molecular epidemiology of thalassemia in Jiaxing area of Zhejiang province and provide a basis for prenatal diagnosis, genetic counseling and prevention and control of birth defects. Methods A total of 24 003 pregnant women who presented at the Jiaxing Maternal and Child Health Care Hospital from April 2017 to September 2021 were enrolled. Capillary hemoglobin electrophoresis in combination with routine blood test were used for primary screening for carriers of thalassemia-associated mutations, and those with positive results were subjected to fluorescence quantitative PCR assay. Prenatal diagnosis was provided for couples with a risk of giving birth to children with intermediate or severe thalassemia. Results Among the 24 003 pregnant women, 1 211 cases were suspected as carriers of thalassemia-associated mutations, among whom 443 (36.58%) were confirmed by genetic testing. Among these, carriers of α-, β- and α-complex β-globin gene mutations have accounted for 27.31% (121/443), 70.65% (313/443) and 2.04% (9/443), respectively. The result of prenatal diagnosis for an at-risk couple was -- SEA/αCSα, and the fetus was predicted to have intermediate or severe thalassemia. Termination of the pregnancy was recommended. Conclusion Hemoglobin electrophoresis combined with routine blood test during pregnancy may be used as a preliminary screening measure for carriers of thalassemia-associated variants. Combined with genetic testing, this will be of great significance for the control of thalassemia in this region.

    地中海贫血基因型嘉兴地区荧光定量PCR

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    圆头精子症患者的致病基因变异分析4例

    唐珍珍李清琴陈国勇黄吴键...
    301-307页
    查看更多>>摘要：目的 对4例圆头精子症患者的致病基因进行分析，明确其遗传学病因。 方法 选取2017年6月至2020年9月在中国人民解放军联勤保障部队第九〇〇医院被确诊为圆头精子症的4例患者作为研究对象，采集其精液和血液样本，进行精子浓度、活力、存活率、形态等常规检测以及精子顶体抗原CD46免疫荧光检测，提取外周血样基因组DNA进行全外显子组测序(WES)，对疑似致病变异通过Sanger测序进行验证。 结果 WES检测显示4例患者均携带DPY19L2基因变异，其中患者1 ~ 3携带DPY19L2基因纯合缺失，Sanger测序显示患者3在重组断裂点区域BP2存在断裂，通过非等位基因同源重组造成DPY19L2基因完全缺失。患者1存在第2 ~ 22外显子纯合缺失，患者2存在第14 ~ 15外显子纯合缺失，患者1和2的缺失既往未见文献报道，患者4为DPY19L2基因杂合缺失，且3′ UTR区存在罕见的纯合缺失。 结论 DPY19L2基因变异可能导致的圆头精子症的发生，其方式符合常染色体隐性遗传，同时也符合基因组病的特点。 Objective To explore the genetic basis for 4 patients with globozoospermia. Methods Semen and blood samples were collected from the patients for the determination of sperm concentration, viability, survival rate, morphology and acrosome antigen CD46. Meanwhile, DNA was extracted for whole exome sequencing (WES), and candidate variants were validated by Sanger sequencing. Results All of the four patients were found to harbor variants of the DPY19L2 gene. Patients 1 ~ 3 had homozygous deletions of the DPY19L2 gene. Sanger sequencing confirmed that the DPY19L2 gene in patient 3 was disrupted at a recombination breakpoint area BP2, resulting in nonallelic homologous recombination and complete deletion of the DPY19L2 gene. Patients 2 and 3 respectively harbored novel homozygous deletions of exons 2 ~ 22 and exons 14 ~ 15. Patient 4 harbored heterozygous deletion of the DPY19L2 gene, in addition with a rare homozygous deletion of the 3′ UTR region. Conclusion DPY19L2 gene variants probably underlay the globozoospermia in the four patients, which has fit an autosomal recessive pattern of inheritance and the characteristics of genomic diseases.

    圆头精子症基因检测DPY19L2基因

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    拷贝数变异测序在智力障碍、发育迟缓及孤独谱系综合征的病因学分析中的应用

    雷洁赵刚黄彦科龙敏...
    308-316页
    查看更多>>摘要：目的 探讨拷贝数变异测序(CNV-seq)对于智力障碍(ID)、发育迟缓(DD)及孤独谱系障碍(ASD)患儿的诊断价值。 方法 收集2018年9月至2022年1月在深圳市南山区妇幼保健院诊断为ID、DD及ASD的患儿40例，采集其外周血样，分别进行染色体核型分析和CNV-seq检测，查询ClinVar、DECIPHER、OMIM等数据库并结合生物信息学分析评估拷贝数变异(CNVs)的致病性。 结果 40例患者检测出ID 16例(40.0%)、DD 15例(37.5%)、ASD 6例(15.0%)、ID合并DD为1例，ID合并ASD为2例。核型分析发现47，XY，+mar、46，XY，inv(8)(p11.2q21.2)、46，XX，del(5)(p14)以及46，XX[76]/46，X，dup(X)(p21.1q12)各1例，染色体多态性2例。CNV-seq在20例患儿中共检出32处CNVs，检出率(50.0%)明显高于核型分析。在10例(25.0%)患儿中发现了致病性CNVs(检出率为25.0%)，12例患者中发现了15处意义未明的CNVs(检出率为30.0%)，4例患者中发现了7处良性/可能良性的CNVs(检出率为10.0%)。 结论 基因组CNVs是ID/DD和ASD重要的遗传学病因，CNV-seq可为明确其病因提供重要的参考。 Objective To assess the value of copy number variation sequencing (CNV-seq) for the diagnosis of children with intellectual disability (ID), developmental delay (DD), and autistic spectrum disorder (ASD). Methods Forty patients with ID/DD/ASD referred to Nanshan Maternity and Child Health Care Hospital from September 2018 to January 2022 were enrolled. G-banded karyotyping analysis was carried out for the patients. Genomic DNA was extracted from peripheral blood samples and subjected to CNV-Seq analysis to detect chromosome copy number variations (CNVs) in such patients. ClinVar, DECIPHER, OMIM and other database were searched for data annotation. Results Among the 40 patients (including 30 males and 10 females), 16, 15 and 6 were diagnosed with ID, DD and ASD, respectively. One patient had combined symptoms of ID and DD, whilst the remaining two had combined ID and ASD. Four patients were found with abnormal karyotypes, including 47, XY, + mar, 46, XY, inv(8)(p11.2q21.2), 46, XX, del(5)(p14) and 46, XX[76]/46, X, dup(X)(p21.1q12). Chromosome polymorphism was also found in two other patients. CNV-seq analysis has detected 32 CNVs in 20 patients (50.0%, 20/40). Pathogenic CNVs were found in 10 patients (25.0%), 15 CNVs of uncertain clinical significance were found in 12 patients (30.0%), and 7 likely benign CNVs were found in 4 patients (10.0%). Conclusion Chromosome CNVs play an important role in the pathogenesis of ID/DD/ASD. CNV-seq can detect chromosomal abnormalities including microdeletions and microduplications, which could provide a powerful tool for revealing the genetic etiology of ID/DD/ASD patients.

    拷贝数变异智力障碍发育迟缓孤独谱系障碍测序

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