4例SRY阳性的46,XX男性综合征患者临床及细胞分子遗传学研究

目的:探讨SRY阳性的46,XX男性综合征患者的临床及细胞分子遗传学特征。方法:分析4例SRY阳性的46,XX男性综合征患者的临床特点,并进行染色体核型分析、荧光原位杂交(FISH)、SRY基因检测、Y染色体微缺失等细胞和分子遗传学检测。结果:4例患者社会性别均为男性,身材低于正常男性均值。均因不育就诊,双侧睾丸体积小、质地软,精液检查均为无精子症。阴茎发育正常。性激素检查示高促性腺激素性性腺功能不全。染色体核型均为46,XX,Y染色体微缺失检测示AZFa,b,c区域均缺失。SRY基因均存在,FISH结果3例患者显示SRY基因易位于X染色体短臂。结论:SRY阳性的46,XX男性综合征患者常为男性表型,但睾丸发育不良,多伴有身材矮小和不育。患者的男性表型是由于基因组中存在SRY基因。无精子表型是由于缺失AZF。Y染色体长臂上可能存在与身高相关的基因。深入进行细胞、分子遗传学研究有助于揭示46,XX男性综合征基因型-表型的关系。     

4例SRY阳性的46，XX男性综合征患者临床及细胞分子遗传学研究

目的：探讨SRY阳性的46，XX男性综合征患者的临床及细胞分子遗传学特征。方法：分析4例SRY阳性的46，XX男性综合征患者的临床特点，并进行染色体核型分析、荧光原位杂交（FISH）、SRY基因检测、Y染色体微缺失等细胞和分子遗传学检测。结果：4例患者社会性别均为男性，身材低于正常男性均值。均因不育就诊，双侧睾丸体积小、质地软，精液检查均为无精子症。阴茎发育正常。性激素检查示高促性腺激素性性腺功能不全。染色体核型均为46，XX，Y染色体微缺失检测示AZFa，b，C区域均缺失。SRY基因均存在，FISH结果3例患者显示SRY基因易位于X染色体短臂。结论：SRY阳性的46，XX男性综合征患者常为男性表型，但睾丸发育不良，多伴有身材矮小和不育。患者的男性表型是由于基因组中存在SRY基因。无精子表型是由于缺失AZF。Y染色体长臂上可能存在与身高相关的基因。深入进行细胞、分子遗传学研究有助于揭示46，XX男性综合征基因型-表型的关系。     

46,XX男性性反转综合征1例的基因检测

目的探讨46，XX男性性反转综合征的临床表现及诊治要点。方法回顾分析1例46，XX男性性反转综合征患者的临床表现、激素水平及核型分析结果，并采用聚合酶链反应（PCR）及荧光原位杂交技术（FISH）对其Y染色体上的性别决定区（SRY）基因进行检测。结果通过PCR扩增检测发现患者SRY基因阳性，但FISH显示其SRY基因易位于X染色体上。结论SRY基因是参与性别决定和分化的关键基因，对其进行检测有利于明确性反转综合征的临床诊断。SRY基因易位于X染色体或其他常染色体是导致性反转综合征的重要原因之一。     

46,XX男性性别逆转综合征(附四例报告)

目的　总结 4 6 ,XX男性性别逆转综合征患儿的临床、内分泌和遗传学特点。　方法　回顾分析 4例 4 6 ,XX男性性别逆转综合征患儿的临床资料。　结果　 4例患儿社会性别均为男性 ,2例隐睾 ,3例尿道下裂 ,1例重度阴茎下曲伴短尿道畸形 ;B超及盆腔手术探查未见卵巢、子宫 ;血清性激素水平检查提示为高促性腺激素型性腺功能不全 ;染色体核型为 4 6 ,XX。　结论　 4 6 ,XX男性性别逆转综合征表型接近正常男性 ,但有睾丸发育不良 ,多数不育 ,治疗重点在于矫正泌尿生殖系统畸形和青春期雄激素替代治疗。     

46,XX男性性反转综合征遗传学诊断及临床分析

目的通过对66例46,XX男性性反转综合征患者进行细胞及分子遗传学分析,探讨性分化异常的机制及临床特点。方法外周血淋巴细胞染色体核型分析,PCR扩增Y染色体长臂上AZF基因位点。结果 66例患者染色体核型分析均为46,XX,PCR扩增显示SRY基因阳性、AZFa、b、c、d区全部存在2例,SRY基因阳性、AZFa、b、c、d区全部缺失56例,SRY基因阴性、AZFa、b、c、d区全部缺8例。结论 46,XX男性性反转综合征患者临床男性表型,在遗传学上表现出明显的异质性,SRY基因缺失的患者也能发育成临床男性表型,提示在男性性别的决定和分化过程中,可能存在多种关键性影响因素。     

46,XX男性综合征患者细胞分子遗传学研究

目的:探讨46,XX男性综合征患者细胞分子遗传学特征.方法:对1例46,XX男性综合征患者的临床特点进行回顾性分析,进行外周淋巴细胞染色体核型分析,对其SRY基因、Y染色体微缺失进行检测分析.并以正常男性及女性作对照.结果:该患者社会性别为男性,身材较正常同龄男性身高均值低.因不育就诊,双侧睾丸体积小、质地中等,精液检查示无精子症.阴茎发育正常.B超检查示前列腺发育正常,未见到子宫、卵巢等女性生殖器官.性激素检查正常.染色体核型为46,XX(SRY+),Y染色微缺失检测示AZFa,AZFb,AZFc及AZFd区域均缺失.结论:基因组中存在SRY基因可能与该例46,XX男性综合征患者为男性表型密切相关.无精子症表型可能是缺乏位于Y染色体AZF区与精子生成相关基因造成的.     

外生殖器畸形患者遗传学检查的临床意义

目的 探讨遗传学检查在生殖器发育畸形患者临床诊断和治疗中的作用.方法 收集20例不同程度外阴发育异常患者的外周血,运用G显带技术进行染色体核型分析,PCR技术检测SRY基因(sex-determining region of Y chromosome,SRY).结果 6例真两性畸形的核型为46,XX;45,X;46,XX/46;XY和46,XX/47,XXY,其中1例46,XX个体的SRY(-),其余5例SRY(+);6例男性假两性畸形,存在睾丸组织,核型均为46,XY,且SRY(+);2例女性假两性畸形,具子宫及卵巢,核型46,XX,SRY(-);1例46,XY女性综合征,具子宫及双侧卵巢间质,核型46,XY,SRY(-);1例46,XX男性综合征,隐睾,核型46,XX,SRY(+);3例母孕期药物影响女婴,具子宫及卵巢,核型46,XX,SRY(-);1例肥胖引起的埋藏阴茎,核型46,XY,SRY(+).结论 临床上对生殖器发育畸形患者进行核型分析和SRY基因检测,有利于早期对性腺发育的判断,促进疾病的诊断和治疗.妇女孕期性激素的使用应加强管理.     

性分化异常病人SRY基因检测的临床意义

目的：为探讨Y染色体上性别决定区基因（SRY）在性分化中的作用。方法：在染色体核型分析的基础上，应用聚合酶链反应（PCR）对4例性分化异常的病人进行SRY检测、结果：2例46，XX男性中1例SRY阳性，1例SRY阴性．2例46，XY女性SRY阳性。结论：SRY基因检测在性分化异常的诊断中有重要意义，但性别决定是一个复杂的过程，不排除还有除SRY以外的遗传机制参与。     

46,XX男性性反转综合征4例报道

目的报道4例46,XX男性性反转病例,结合相关文献探讨性反转综合征的临床特点。方法对其外周血淋巴细胞进行核型分析。结果 4例患者染色体核型均为46,XX,结合临床、B超、性激素检查诊断为46,XX男性性反转综合征。结论对男性生殖器发育异常、睾丸偏小、无精子并性激素异常等患者,有必要进行染色体检查及SRY基因检测,有助于明确诊断。     

SRY调控性腺分化研究的进展

人类性腺的分化是由基因所决定的。在胚胎的未分化性腺分化为睾丸或卵巢时 ,性别就决定了。这个过程是一个复杂而精细的过程。位于Y染色体上SRY基因表达 ,引发了一个复杂的遗传过程 ,导致了睾丸的分化。然而 ,仅有少数 4 6 ,XY性反转的患者检出SRY基因的突变。其他参与性腺分化的基因有待发现。最近的研究工作表明 ,睾丸的分化受到胰岛素受体家族基因的调控 ,正常情况下SRY需通过两个不同的核运输途径使足够剂量的SRY蛋白进入细胞核调控性腺分化过程。     

46, XX male sex reversal syndrome: a case report and review of the genetic basis

Sex reversal syndrome is a kind of human genetic disease about gender dysplasia, which is characterised by inconsistency between gonadal sexuality and chromosome sexuality; the incidence rate was about 1 : 20 000–100 000. The clinical manifestations, hormonal levels and cytogenetic findings in a patient of 46, XX male sex reversal syndrome retrospectively were analysed and related published reports were reviewed. The DNA fragments of sex-determining region Y (SRY) gene from the patient was found by polymerase chain reaction, but the fluorescent in situ hybridisation analysis revealed that the SRY translocated from Y to X chromosome. We concluded that the Y chromosomal SRY gene is required for the regulation of male sex determination. The detection of SRY is important for the clinical diagnosis of sex reversal syndrome. Translocation of SRY to X chromosome or other autosomes would be one of the key factors that induced XX male SRS.     

应用SRY基因检测性发育异常的研究

性分化异常与Ｙ染色体有直接的联系，而睾丸的发生与Ｙ染色体短臂上１Ａ１Ａ性别决定区（ＳＲＹ）基因密切相关。本文对表型男性的４６，ＸＸ和表型女性的４６，ＸＹ、４５，Ｘ／４６，Ｘ，ｔ（Ｙ；Ｙ）、４６，ＸＹ，表型女性盆腔肿瘤、４６，ＸＹ，外生殖器官及性腺发育异常、Ｘ染色体与常染色体易位的原发闭经等六个类型１６例病人应用ＰＣＲ技术进行ＳＲＹ基因的体外扩增检测。结果１２例ＳＲＹ阳性，４例ＳＲＹ阴性，为临床诊断治疗提供了依据。     

Localization of the sex-determining region-Y gene in XX males

Localization of the sex-determining region Y (SRY) was investigated in 2 XX males. Metaphase chromosomes from peripheral lymphocytes were stained by fluorescence in situ hybridization using DXZ1 and SRY probes. An identical hybridization signal with the SRY probe was found on an X chromosome in both cases. The karyotype of the 2 cases was 46,XX, t(X;Y)(p22.3;p11.3). It would appear that XX male is the presence of a Y-chromosome fragment transferred to the X-chromosome short arm by unequal interchange between homologous regions in the short arms of sex chromosomes.     

SRY-positive 46,XX male with cryptorchidism as the only presenting clinical feature

The SRY gene, located on the short arm of the Y chromosome, is responsible for differentiation of the testis from the undifferentiated gonad. We report a 4-year-old patient with male phenotype and female karyotype (46,XX) with cryptorchidism as the only presenting clinical abnormality. Fluorescent in situ hybridization analysis, using Y- and X-specific (whole chromosome painting WCP Y WCP X) DNA and SRY probes, detected a small Y chromosome fragment, including the SRY gene, transferred to the short arm of the X chromosome.     

A missense mutation (c.226C>A) in HMG box SRY gene affects nNLS function in 46,XY sex reversal female

The SRY initiates cascade of gene expression that transforms the undifferentiated gonad, genital ridge into testis. Mutations of the SRY gene is associated with complete gonadal dysgenesis in females with 46,XY karyotype. Primary amenorrhea is one of the clinical findings to express the genetic cause in 46,XY sex reversal. Here, we report a 26-year-old married woman presenting with primary amenorhea and complete gonadal dysgenesis. The clinical phenotypes were hypoplastic uterus with streak gonad and underdeveloped secondary sexual characters. The cytogenetic analysis confirmed 46,XY sex reversal karyotype of a female. Using molecular approach, we screened open reading frame of the SRY gene by PCR and targeted DNA Sanger sequencing. The patient was confirmed with nucleotide substitution (c.226C>A; p.Arg76Ser) at in HMG box domain of SRY gene that causes 46,XY sex reversal female. Mutation prediction algorithms suggest that alteration might be disease causing mutation and mutated (p.Arg76Ser) amino acid deleteriously affects HMG box nNLS region of SRY protein. Clinical phenotypes and in silico analysis confirmed that missense substitution (p.Arg76Ser) impaired nNLS binding Calmodulin-mediated nuclear transport of SRY from cytoplasm to nucleus. The mutation affects down regulation of male sex differentiation pathway and is responsible for 46,XY sex reversal female with gonadal dysgenesis.     

Prophylactic bilateral salpingo-oopherectomy in a 17-year-old with Frasier syndrome reveals gonadoblastoma and seminoma: a case report

Mutations in the Wilms' tumor gene are present in children with Frasier syndrome, Denys-Drash syndrome, WAGR syndrome, and some cases of Wilms' tumor. The Wilms' tumor gene product, WT1, is necessary for normal urogenital development. Frasier syndrome is an association between focal segmental glomerulosclerosis, beginning in the second and third decade, male to female sex reversal, and dysgenetic gonads.We report a case of Frasier syndrome in a 17-year-old adolescent girl with renal failure, kidney transplant, and dysgenetic gonads, with development of gonadoblastoma and dysgerminoma (seminoma). The diagnosis of Frasier syndrome was based on nephrotic syndrome with diffuse mesangial sclerosis leading to chronic renal failure, dysgenetic gonads, 46 XY karyotype in a phenotypic female, and a mutation in the Wilms' tumor gene. Prophylactic laparoscopic bilateral salpingo-oopherectomy revealed gonadoblastoma and seminoma in opposite atrophic ovaries as well as a hypoplastic uterus.Early prophylactic resection of dysgenetic gonads is indicated in children with Frasier syndrome to prevent the development of germ cell malignancy.     

性反转综合征病人中SRY基因的PCR筛查

SRY基因是继ZFY基因之后新近克隆的TDF的最佳候选基因。本文采用SRY/Y—重复DNA双重PCR对8例性反转综合征患者进行了 SRY基因的筛查。结果表明,在4例典型的46,XX男性患者的基因组中均存在有 SRY基因序列,但无Y重复DNA存在。表明 SRY基因所在的Y-DNA序列与46,XX男性综合征的发生相关。在4例46,XY女性中,其SRY基因均未发生缺失,说明其性反转的发生不是因SRY基因的缺失所致,而可能存在有其它的遗传机制导致其性反转的发生,如SRY基因的突变等。     

性分化异常患者SRY基因检测的临床意义

为探讨Ｙ染色体上性别决定区基因（ＳＲＹ）在性分化中的作用,在染色体核型分析的基础上,应用聚合酶链反应（ＰＣＲ）对２例４６,ＸＸ男性,２例４６,ＸＹ女性进行ＳＲＹ检测。实验发现,２例４６,ＸＸ男性中１例ＳＲＹ阳性,１例ＳＲＹ阴性,２例４６,ＸＹ女性ＳＲＹ阳性。结果表明,ＳＲＹ基因检测在性分化异常的诊断中有重要意义。但同时提出性别决定是一个复杂的过程,不排除还有除ＳＲＹ以外的遗传机制参与。