Bethlem肌病一家系病例报告并文献复习

目的本文报道一常染色体显性遗传的Bethlem肌病家系共三代人的临床表现、病理学和遗传学特点。方法采集家系成员临床资料,分析肌肉病理改变及行基因测序,并从伴关节挛缩和关节过松的肌病两方面讨论其鉴别诊断思路。结果该家系主要临床表现为肘、腕、远端指间关节及跟腱挛缩,远端关节松弛,近端肌无力及皮肤症状,肌肉病理表现为非特异性肌营养不良改变。结论本研究总结Bethlem肌病病诊断要点,达到提高临床医师对Bethlem肌病这一罕见病认识的目的。     

FHL1基因突变相关遗传性肌病一家系临床特征分析

4个半LIM1结构域蛋白(four and a half LIM domains 1,FHL1),也称为骨骼肌LIM蛋白1,是一个高表达于骨骼肌和心肌的多功能蛋白,人体其他组织如卵巢、肾脏、肺等中也可观察到部分FHL1蛋白表达^[1,2,3]。研究发现FHL1蛋白位于成熟骨骼肌肌节的I带和M线上,可能具有转录因子、细胞骨架支架以及生物机械应激反应等生理功能^[4,5,6,7]。FHL1基因突变可能导致多种不同类型的肌病,如还原体肌病(reducing body myopathy,RBM)、X连锁显性遗传肩胛骨腓骨肌病(X-linked dominant scapuloperoneal myopathy,XSPM)、X连锁肌病伴体位性肌萎缩(X-linked recessive myopathy with postural muscle atrophy,XMPMA)和Emery-Dreifuss肌营养不良(Emery Dreifuss muscular dystrophy,EDMD)等^[8,9,10]。该基因突变较为罕见,相关的临床表型异质性较大,临床诊断具有极大的挑战性。北京协和医院神经内科曾收治1例FHL1基因突变相关遗传性肌病患者,现总结分析其临床表现及家系特点,希望提高临床医师对该病的认识。     

Nonaka肌病的GNE基因突变研究

目的报告2例Nonaka肌病的GNE基因突变特点。方法对2例经临床和病理检查证实的Nonaka 肌病,用PCR和DNA测序方法检测GNE基因编码区外显子及其侧翼序列,对例1家系中3代共7人也作该基因的突变检查。结果例1在GNE基因外显子8出现1 525C→T纯合突变;例2在外显子2出现527A→T杂合突变和外显子9出现1714G→C杂合突变,上述突变分别造成GNE出现H509Y的纯合突变以及D176V和V572L的复合杂合突变。例1的家系中患者的父母分别为H509Y的杂合突变。结论我们这2例Nonaka肌病患者的发病均是由GNE 基因突变所致,其中H509Y突变为新发现的突变类型。同时也证实我国Nonaka肌病也存在日本患者GNE的热点突变。     

DNAJB6基因突变致显性遗传性肌病一家系并文献复习

目的 总结常染色体显性遗传性DNAJB6基因突变所致肌病的临床表型和基因突变特点.方法 回顾分析一家系2例DNAJB6基因突变所致肌病患者的临床表现、实验室、肌肉影像学、神经电生理学、肌肉病理学和基因检测结果,并进行文献复习.结果 先证者主要表现为四肢远近端肌无力,下肢重于上肢、近端重于远端,其父呈姿势异常,上楼需扶持...     

遗传性痉挛性截瘫一家系临床及spastin基因突变的特点

目的 探讨遗传性痉挛性截瘫(SPG)一家系临床及基因突变的特点.方法 回顾性分析一个SPG家系的临床资料.结果 该家系内5代共有5例SPG患者,各代均有发病.3例存活患者均为女性,发病年龄16 ～21岁,平均18.3岁;病程11 -58年,平均33.3年;3例患者临床表现为缓慢进展的双下肢无力,下肢肌张力明显增高.基因检测显示3例患者spastin基因c.1098+1～2gt→ctcaga突变,家系中正常成员未见该变异.结论 该SPG家系的遗传方式为常染色体显性,临床表现为单纯性SPG,为spastin基因c.1098+1 ～ 2gt→ctcaga突变所致.     

肢带型肌营养不良症2D型一家系临床表型及基因突变分析

目的总结肢带型肌营养不良症2D型(LGMD2D型)临床表型和基因突变特点。方法报道一家系2例女性LGMD2D型患儿临床表现、肌电图、肌肉MRI、肌肉病理学和基因检测结果,并结合相关文献进行分析。结果先证者及其妹均于3岁发病,以进行性四肢近端无力为主要临床表现;血清肌酸激酶水平显著升高;肌电图呈肌源性损害;肌肉MRI显示部分肌肉萎缩、脂肪化或纤维水肿;其妹肌肉病理学显示局灶性骨骼肌坏死、再生,部分横纹肌消失,肌纤维大小不等。基因检测显示,先证者及其妹存在相同基因突变,即SGCA基因第3外显子移码突变c.262del T(p.Phe88SerfsX123)和第5外显子错义突变c.409GA(p.Glu137Lys),其母为SGCA基因c.409GA(p.Glu137Lys)突变携带者,其中,c.409GA(p.Glu137Lys)为已知突变,c.262del T(p.Phe88SerfxX123)为新发突变。结论对于临床类似Duchenne型肌营养不良症的女性患者,排除DMD基因携带者后,还应行家系分析和肢带型肌营养不良症相关基因检测,以明确具体亚型。     

FHL1基因突变相关遗传性肌病一家系临床特征分析

4个半LIM1结构域蛋白(four and a half LIM domains 1, FHL1), 也称为骨骼肌LIM蛋白1, 是一个高表达于骨骼肌和心肌的多功能蛋白, 人体其他组织如卵巢、肾脏、肺等中也可观察到部分FHL1蛋白表达[1,2,3]。研究发现FHL1蛋白位于成熟骨骼肌肌节的I带和M线上, 可能具有转录因子、细胞骨架支架以及生物机械应激反应等生理功能[4,5,6,7]。FHL1基因突变可能导致多种不同类型的肌病, 如还原体肌病(reducing body myopathy, RBM)、X连锁显性遗传肩胛骨腓骨肌病(X-linked dominant scapuloperoneal myopathy, XSPM)、X连锁肌病伴体位性肌萎缩(X-linked recessive myopathy with postural muscle atrophy, XMPMA)和Emery-Dreifuss肌营养不良(Emery Dreifuss muscular dystrophy, EDMD)等[8,9,10]。该基因突变较为罕见, 相关的临床表型异质性较大, 临床诊断具有极大的挑...     

TIA1基因突变致Welander远端型肌病一家系的临床特点与遗传分析

目的 讨论1个Welander远端型肌病家系中患者的临床特点,分析该家系患者中的TIA1基因突变的遗传特征。 方法 收集2018年2月中山大学附属第一医院收治的一个Welander远端型肌病家系中患者的临床资料、电生理检查与病理结果等,对先证者进行全外显子测序技术基因检测,分析可能的致病突变位点,并针对与临床表型密切相关的基因突变在家系内进行Sanger测序验证。 结果 该家系中先证者为男性,30岁,临床表现主要为进行性四肢远端无力伴肌萎缩,随后出现近端受累,全外显子测序检测到与Welander远端型肌病密切相关的TIA1基因c.91G>A突变。追问家族史后对多位家系成员进行Sanger测序,在先证者母亲、大弟、小舅均检出该同一位点的杂合突变,他们都具有类似四肢无力、萎缩等症状。先证者小弟为突变基因携带者,未出现相应症状,电生理检查提示早期的肌源性损害。 结论 Welander远端型肌病是一种缓慢进展的常染色体显性遗传性疾病,主要表现为四肢远端为主的肌无力与肌肉萎缩。本家系患者主要以下肢远端起病,四肢远端近端皆受累,临床表现具有异质性。基因检测提示该家系所携带TIA1基因c.91G>A突变为其致病突变。     

Calpain蛋白病的临床表型和基因型分析（附一家系报道）

目的：分析比较一对疑为calpain蛋白病变中国姐弟的capn3基因型和临床表型。方法：对其姐进行肌肉活检作病理学检查和calpain-3/dysferlin联合免疫印迹检测。根据文献设计引物,采集该17岁的姐姐和13岁的弟弟外周血进行capn3基因全部24个外显子直接测序,同时行MRI以观察肌肉组织受累情况。结果：本研究为首次对国内肢带型肌营养不良症2A（LGMD 2A）患者进行基因筛查。姐姐表现为典型LGMD症状,伴有翼状肩及跟腱挛缩,MRI亦提示大腿后群肌肉受累;免疫印迹检测结果提示为calpian蛋白病患者。直接测序发现姐弟均携带capn3基因的一个位点错义突变c.146G〉A及另一个位点c.329G〉A。本研究还对c.329G〉A位点在110名正常人血标本进行单核苷酸多态性分析,仅1例携带杂合突变,预测软件提示此位点改变无显著意义。弟弟携带同样的基因突变,但表现为无症状的高磷酸肌酸激酶（CK）血症。结论：calpain蛋白病患者中,相同的基因型可以出现不同的临床表型,不仅可表现为LGMD2A,而且还可以表现为无症状高CK血症。     

ZASP基因突变所致肌原纤维病一家系报道及文献复习

目的通过对ZASP基因突变所致肌原纤维病一家系报道及文献复习,了解该病的临床、病理及基因突变特点。方法分析1例远端肌病患者的临床、肌肉MRI及肌肉病理特点,并追踪其家系家族史。先证者外周血提取DNA,进行目标区序列捕获二代测序(含58个肌病相关基因),明确存在ZASP基因变异。对家系其他成员进行Sanger测序进一步明确及验证突变位点。结果先证者为中年女性,52岁起病,表现为进行性双下肢无力伴双腿变细。先证者家系2代15名中,除先证者外共6名存在肌肉受累,4名为先证者同代亲属,临床特点与先证者类似;2名为先证者下一代亲属,其中1名仅有闭目肌受累及肌酸激酶(CK)轻度升高(291 U·L-1),另1名仅有CK轻度升高(199 U·L-1)。先证者肌肉病理发现肌细胞内有异常嗜伊红物质沉积和镶边空泡形成,免疫组化染色可见肌纤维内desmin蛋白沉积。电镜下可见Z线附近致密颗粒沉积。目标区序列捕获二代测序及Sanger测序确定该家系致病基因为ZASP基因已报道错义突变p.A147T(c.G439A)。结论 ZASP基因突变所致的肌原纤维病家系为国内首次报道。     

Distinct distal myopathy phenotype caused by VCP gene mutation in a Finnish family

Inclusion body myopathy with Paget disease and frontotemporal dementia (IBMPFD) is caused by mutations in the valosin-containing protein (VCP) gene. We report a new distal phenotype caused by VCP gene mutation in a Finnish family with nine affected members in three generations. Patients had onset of distal leg muscle weakness and atrophy in the anterior compartment muscles after age 35, which caused a foot drop at age 50. None of the siblings had scapular winging, proximal myopathy, cardiomyopathy or respiratory problems during long-term follow-up. Three distal myopathy patients developed rapidly progressive dementia, became bedridden and died of cachexia and pneumonia and VCP gene mutation P137L (c.410C > T) was then identified in the family. Late onset autosomal dominant distal myopathy with rimmed vacuolar muscle pathology was not sufficient for exact diagnosis in this family until late-occurring dementia provided the clue for molecular diagnosis. VCP needs to be considered in the differential diagnostic work-up in patients with distal myopathy phenotype.     

Molecular Genetic Diagnosis of a Bethlem Myopathy Family with an Autosomal-Dominant COL6A1 Mutation,as Evidenced by Exome Sequencing

BackgroundWe describe herein the application of whole exome sequencing (WES) for the molecular genetic diagnosis of a large Korean family with dominantly inherited myopathy.ConclusionsThis is the first report of identification of COL6A1-mediated Bethlem myopathy in Korea, and indicates the utility of WES for the diagnosis of muscular dystrophy.     

Subtle central and peripheral nervous system abnormalities in a family with centronuclear myopathy and a novel dynamin 2 gene mutation

Mutations in dynamin 2 (DNM2), an ubiquitously-expressed large GTPase, cause autosomal dominant centronuclear myopathy (DNM2-CNM) and AD Charcot-Marie-Tooth disease type 2B (DNM2-CMT2B). We report a series of 5 patients from the same family who all presented with dominant centronuclear myopathy, mild cognitive impairment, mild axonal peripheral nerve involvement, and the novel E368Q mutation in the DNM2 gene. This study suggests that the phenotypes of dynamin 2 related centronuclear myopathy and Charcot-Marie-Tooth disease overlap and that DNM2 mutations may alter cerebral function. This report extends the clinical knowledge of DNM2-centronuclear myopathy and shows that the role of DNM2 mutations in the central nervous system should be further studied.     

The clinical and myopathological features of oculopharyngodistal myopathy in a Chinese family

Oculopharyngodistal myopathy is a rare type of hereditary myopathy characterised pathologically by the changes of muscular dystrophy with rimmed vacuoles and intra‐muscular tubulofilamentous inclusions. Here we report the clinical and myopathological changes in a Chinese family with oculopharyngodistal myopathy. The proband showed external ophthalmoplegia, dysphagia, distal weakness and atrophy in all extremities. Serum creatine kinase level was mildly elevated and a myopathic pattern with myotonic discharge was demonstrated by electromyography (EMG). Molecular genetic analysis showed that the number of trinucleotide repeat expansions in the polyadenylate‐binding protein nuclear 1 gene was within the normal limit. No mutations were indentified in the GNE gene. Five other persons with similar symptoms were found in the same generation. Muscle biopsy was performed on the tibialis anterior muscle in the proband. Muscular dystrophy changes with rimmed vacuoles were the main histopathological changes. Ultrastructural examination revealed numerous tubulofilamentous inclusions in both sarcoplasm and nucleus. EMG showed myotonic discharges in oculopharyngodistal myopathy. In addition to the sarcoplasm inclusions, we confirmed that tubulofilamentous inclusions appeared also in the nucleus.     

关于临床判断致病性突变和无害突变的思考

<正>近年来,二代基因测序(NGS)技术的普及使诸多既往难以确定的、遗传异质性较强的疾病,如肌萎缩侧索硬化症(ALS)、腓骨肌萎缩症(CMT)、遗传性痉挛性截瘫(HSP)、脊髓小脑共济失调(SCA)、肢带型肌营养不良症(LGMD)等的致病性突变位点得以明确,为临床诊断与遗传咨询提供重要信息。然而,临床上常可以看到这样一种现象,临床医师在面对二代基因测序技术提供的遗传学信息时仍十分困惑,这是由于有些基因检测结果与临床表型     

TWINKLE gene mutation: report of a French family with an autosomal dominant progressive external ophthalmoplegia and literature review

Background: Multiple mitochondrial DNA (mtDNA) deletions usually have a mendelian inheritance secondary to mutation in nuclear genes. One of these is the Twinkle gene whose mutation is responsible for autosomal dominant progressive external ophthalmoplegia (PEO). The number of reported cases with mainly myopathic symptoms and possible nervous system involvement related to Twinkle gene mutation is limited. We present a new French family of whom two members displayed myopathy and neuropathy associated with PEO, and we perform a clinical review in light of other observations reported in the literature. Methods: The proband, one son and the daughter have been investigated. Southern blot analysis and long‐range PCR assay have been performed from muscle biopsy specimens. Coding exons and flanking intron regions of polymerase gamma (POLG) and DNA helicase (Twinkle) genes were sequenced. Results: Multiple mitochondrial DNA deletions have been found and sequencing of the Twinkle gene showed the change p.R374Q. Conclusion: Two other families from the literature also had the R374Q mutation. Symptoms reported in association with this mutation were myopathy, peripheral neuropathy, dysarthria and/or dysphagia, respiratory insufficiency and parkinsonism. Respiratory insufficiency caused by chest wall weakness was reported in other families with different Twinkle gene mutations, and one might provide exercise intolerance, dysarthria and/or dysphagia as symptoms in favor of the diagnosis. Occurrence of impressive emaciation was a peculiarity in our family.     

肯尼迪病的临床特征与基因突变四例

目的探讨肯尼迪病(KD)的临床特征与基因突变。方法分析4例经基因确诊的KD患者的临床资料。结果 4例患者均为男性,发病年龄分别为35、47、48、36岁,例2有家族史,例4既往双手静止性震颤10余年,4例均以肢体无力起病并以肢体无力为主要症状,例2、例3、例4伴有舌肌萎缩及纤颤,例4伴明显的面部及腹部肌肉跳动。例1初诊未确诊,例2误诊为肌炎,例3误诊为运动神经元病。4例血清肌酸激酶均升高;肌电图(EMG)4例均呈广泛慢性神经源性损害;例1、例2、例3肌肉病理示神经源性损害伴肌源性损害;4例患者雄激素受体基因外显子中CAG重复序列次数均40(分别为53、51、49、52)。结论 KD的临床特点为缓慢进展的延髓和四肢近端肌肉萎缩无力,可伴有内分泌或代谢异常;肌肉病理以神经源性损害为主,多伴肌源性损害。KD临床表现常不典型,需与多种疾病鉴别,基因检测可确诊。     

Novel TPM3 mutation in a family with cap myopathy and review of the literature

Cap myopathy is a rare congenital myopathy characterized by the presence of caps within muscle fibres and caused by mutations in ACTA1, TPM2 or TPM3. Thus far, only three cases with TPM3-related cap myopathy have been described. Here, we report on the first autosomal dominant family with cap myopathy in three-generations, caused by a novel heterozygous mutation in the alpha-tropomyosin-slow-encoding gene (TPM3; exon 4; c.445C>A; p.Leu149Ile). The three patients experienced first symptoms of muscle weakness in childhood and followed a slowly progressive course. They presented generalized hypotrophy and mild muscle weakness, elongated face, high arched palate, micrognathia, scoliosis and respiratory involvement. Intrafamilial variability of skeletal deformities, respiratory involvement and mild cardiac abnormalities was noted. Muscle MRI revealed a recognizable pattern of fatty muscle infiltration and masseter muscle hypertrophy. Subsarcolemmal caps were present in 6–10% of the fibres and immunoreactive with anti-tropomyosin antibodies. We conclude that the MRI-pattern of muscle involvement and the presence of masseter muscle hypertrophy in cap myopathy may guide molecular genetic diagnosis towards a mutation in TPM3. Regular respiratory examinations are important, even if patients have no anamnestic clues. We compare our findings to all cases of cap myopathy with identified mutations (n = 11), thus far reported in the literature.