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分析1个遗传性凝血因子Ⅺ缺陷症家系的基因新突变

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目的 探讨1个凝血因子Ⅺ(FⅪ)基因新突变致遗传性FⅪ缺陷症家系临床出血的分子机制.方法 选取2023年2月23日因"腺样体肥大"就诊于山西医科大学附属运城市中心医院的1例遗传性凝血因子XI缺陷症男性先证者及其家系成员(3代5人)作为研究对象.收集先证者及家系成员的临床资料;检测所有成员相关凝血指标;选取凝血指标异常[活化部分凝血活酶时间(APTT)延长,凝血酶时间(PT)与纤维蛋白原(Fib)正常]者进行APTT纠正实验;选取纠正后罗斯纳指数(RI)小于10%者用一步法检测FⅪ活性(FⅪ:C)、用ELISA法检测FⅪ抗原(FⅪ:Ag)、用Illumina测序法测定全外显子序列.根据美国医学遗传学与基因组学学会(ACMG)相关变异评级指南对新突变位点进行评级,用生物信息学软件预测新突变对蛋白质结构及功能的影响.结果 先证者及其父亲、女儿的APTT均延长且RI小于10%;进一步检测发现3人FⅪ:C与FⅪ:Ag均降低;Illumina测序发现3人FⅪ第11号外显子存在c.l223dupC(P.Ser409Leufs*32)新的移码突变,先证者父亲FⅪ第11号外显子还存在c.G1253T(p.Gly418Val)错义突变;ACMG对新突变的评级为:致病性变异,c.G1253T为已报道的可能致病变异.结论 FⅪ第11号外显子c.1223dupC(P.Ser409Leufs*32)杂合移码突变可能为该家系致病的主要分子机制.
Analysis of novel gene mutations in a family with hereditary coagulation factor Ⅺ deficiency
Objective To explore the molecular mechanism of clinical bleeding in a family with hereditary coagulation factor Ⅺ(FⅪ)deficiency caused by a novel mutation of the coagulation factor Ⅺ(F Ⅺ)gene.Methods A male proband with hereditary coagulation factor Ⅺ deficiency who was admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University due to"adenoid hypertrophy"on February 23,2023 and his family members(5 people in 3 generations)were selected as research subjects.The clinical data of the proband and family members were collected;the relevant coagulation indexes of all members were tested;those with abnormal coagulation indexes(prolonged activated partial thromboplastin time(APTT),normal thrombin time(PT)and fibrinogen(Fib))were selected for APTT correction experiment;those with corrected Rosner index(RI)less than 10%were selected to detect FⅪ activity(FⅪ:C)by one-step method,FⅪ antigen(FⅪ:Ag)by ELISA method,and whole exon sequence by Illumina sequencing method.New mutation sites were rated according to the American College of Medical Genetics and Genomics(ACMG)related variation rating guidelines,and bioinformatics software was used to predict the impact of new mutations on protein structure and function.Results The APTT of the proband,his father and his daughter were all prolonged and their RI were all less than 10%.Further tests revealed that FⅪ:C and FⅪ:Ag of the three were all decreased.Illumina sequencing revealed a new frameshift mutation c.1223dupC(P.Ser409Leufs*32)in exon 11 of FⅪ of the three people,and a missense mutation c.G1253T(p.Gly418Val)in exon 11 of FⅪ of the proband's father.ACMG rated the new mutation as pathogenic,and c.G1253T was a reported possible pathogenic mutation.Conclusion The heterozygous frameshift mutation c.1223dupC(P.Ser409Leufs*32)in exon 11 of FⅪ may be the main molecular mechanism of the disease in this family.

Factor Ⅺ DeficiencyInherited coagulation factor Ⅺ deficiencyNovel mutationsBioinformatics

李蕊、谢亚荣、朱伟、李晓颜、刘浩

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运城市中心医院检验科,运城 044000

汾阳医院检验科,汾阳 032200

罗氏诊断有限公司理论与技术部,上海 200335

因子Ⅺ缺乏 遗传性凝分子血因子Ⅺ缺陷症 新突变 生物信息学

山西省卫生健康委科研项目

2020110

2024

中华检验医学杂志
中华医学会

中华检验医学杂志

CSTPCD北大核心
影响因子:1.402
ISSN:1009-9158
年,卷(期):2024.47(8)