散发性肌萎缩侧索硬化单核苷酸多态位点质谱分型及疾病易患性关联分析

目的 肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)是由上、下运动神经元进行性丢失引起的一种致死性疾病,散发性ALS(SALS)近90%,目前认为是一种复杂性疾病.已有数个ALS全基因组关联分析研究先后报道了若干与增加ALS发病风险相关的单核苷酸多态(SNP)位点,但亚洲人资料较少.我们将筛查与增加中国人SALS致病风险相关的SNP.方法 提取样本外周血基因组DNA,进行病例组和对照组年龄、性别匹配,质谱法分型筛选出的SNP位点并进行关联分析.结果 完成86例SALS患者与94名对照者rs6700125、rs10260404、rs1942239、rs2279812、rs2405657、rs558889、rs6922711、rs9351470等8个SNP位点的基因分型,统计分析后两组差异无统计学意义.合并Cronin等研究数据后rs1942239(邻近基因GALNT1)的P值减小(由1.48×10-4减少为9.07×10-5),关联性增强.rs558889的病例组基因频率偏离Hardy-Weinberg平衡,可能存在关联.结论 rs1942239和rs558889两个SNP可能与增加中国人SALS致病风险相关,与rs1942239邻近的GALNT1基因和rs558889附近的ANK1基因值得进一步研究.     

散发性肌萎缩侧索硬化单核苷酸多态位点质谱分型及疾病易患性关联分析

Objective Amyotrophic lateral sclerosis(ALS)is a progressive paralytic disorder resulting from the degeneration of upper and lower motor neurons.Sporadic ALS(SALS)accounm for majority of patients.ALS is a kind of complex disorder.There were several single nucleotide polymorphism (SNP)reported to be associated with SALS in recently published genome-wide association(GWA)study,but there are few data from Asia ALS population and no report focus on SNP which may associated with SALS of Chinese origin.Our study is to screen and add the SNPs related to the risks of SALs in Chinese.Methods Eighty-six individuals with SALS and 94 matched controls were recruited for our study and genomic DNA from blood samples was extracted.Genotypes were determined by a matrix assisted laser desorption/ionization time of flisht mass spectrometry based approach followed by association analysis. Results Individual genotype data for 8 SNPs,rs6700125,rs10260404, rs1942239,rs2279812,rs2405657,rs558889,rs6922711 and rs935 1470 in Chinese population showed no significant association with sporadic ALS.Combining genotype data from published GWA,rs1942239 gained in strength of allelic association(P value decreased to 9.07×10-5 from 1.48×10-4),and rs558889 deviated Hardy-Weinberg equilibrium at ALS case group which may be associated with susceptibility.Conclusions SNP rs1942239 and rs558889 may contribute to susceptibility of sporadic ALS in Chinese patient.The larger sample studies are warranted to confirm the association.     

肌萎缩侧索硬化叠加帕金森综合征临床分析

本文报道了广东省人民医院2例肌萎缩侧索硬化叠加帕金森综合征(ALS-PS)患者的诊断过程,通过文献复习分析了肌萎缩侧索硬化叠加综合征(ALS-Plus)的临床特征、发病率、预后以及可能的发病机制。例1患者表现出运动迟缓和铅管样肌强直的帕金森综合征,左旋多巴冲击试验阴性,无嗅觉减退和痴呆,我们诊断为未分化的ALS-PS。例2患者不仅表现出运动迟缓和铅管样肌强直,同时还有小脑、自主神经功能受累的表现,可以归结到MSA的诊断,故诊断为ALS-MSA。ALS-Plus约占所有ALS患者的13. 6%,并且较单纯ALS患者有更短的生存时间。尽管相关研究尝试为ALSPlus提供合理的解释,但目前具体发病机制仍不完全清楚,有待进一步的研究。ALS-Plus在ALS中并不罕见,但在临床上容易被忽略,一方面因为ALS-Plus对其他系统特别是锥体外系的损伤常常被严重的肌萎缩、肌无力症状所掩盖;另一方面在于神经科医生仍对其缺乏充分的认识。因此,我们认为神经科医生应该加强对ALS-Plus的认识,详细的病史和体格检查有助于避免误诊及漏诊。     

肌萎缩侧索硬化叠加帕金森综合征临床分析

本文报道了广东省人民医院2例肌萎缩侧索硬化叠加帕金森综合征（ALS-PS）患者的诊断过程，通过文献复习分析了肌萎缩侧索硬化叠加综合征（ALS-Plus）的临床特征、发病率、预后以及可能的发病机制。例1患者表现出运动迟缓和铅管样肌强直的帕金森综合征，左旋多巴冲击试验阴性，无嗅觉减退和痴呆，我们诊断为未分化的ALS-PS。例2患者不仅表现出运动迟缓和铅管样肌强直，同时还有小脑、自主神经功能受累的表现，可以归结到MSA的诊断，故诊断为ALS-MSA。ALS-Plus约占所有ALS患者的13.6%，并且较单纯ALS患者有更短的生存时间。尽管相关研究尝试为ALS-Plus提供合理的解释，但目前具体发病机制仍不完全清楚，有待进一步的研究。ALS-Plus在ALS中并不罕见，但在临床上容易被忽略，一方面因为ALS-Plus对其他系统特别是锥体外系的损伤常常被严重的肌萎缩、肌无力症状所掩盖；另一方面在于神经科医生仍对其缺乏充分的认识。因此，我们认为神经科医生应该加强对ALS-Plus的认识，详细的病史和体格检查有助于避免误诊及漏诊。     

二肽基肽酶-6基因多态和散发性肌萎缩侧索硬化发病风险的相关性

目的 探讨中国人二肽基肽酶-6(DPP6)基因中的单核苷酸多态位点rs10260404与散发性肌萎缩侧索硬化(SALS)易患性是否有关.方法 来自中国汉族人群的58例患者与52名健康对照分别提取样本外周血基因组DNA,采用不对称PCR方法扩增包含目标单核苷酸多态位点在内的片段,用高分辨熔解法完成非标记探针的基因分型.结果 SALS患者与健康对照之间rs10260404位点的等位基因频率(SALS组:C:12.94%,T:87.06%;健康对照组:C:10.58%,T:89.43%)差异无统计学意义(χ2=0.29,OR=1.256,95% CI 0.549～2.872,P>0.05).结论 我们未发现DPP6基因中rs10260404位点和中国人SALS的致病风险相关,这可能和ALS本身复杂的遗传异质性有关,但有必要进一步增加病例数以证实.     

肌萎缩侧索硬化诊断及治疗

<正> 概述:肌萎缩侧索硬化(ALS)是一种进展性神经肌肉疾病,由于上、下运动神经元变性导致球部、四肢、躯干的肌肉逐渐无力及萎缩,而动眼肌及括约肌不受累。发病率约1.5/10万,患病率4～6/10万,隐袭起病,进展缓慢,呈致死性,通常由于呼吸衰竭死亡。发病年龄平均55岁,从发病起平均存活3.5年,5年后有20％病人存活,10年有10％存活。5％患者对疾病有抵抗,在发病后可存活20年。一般发病年龄越早,存活时间越长。球部起病者存活期平均约2.2年,     

肌萎缩侧索硬化的免疫学研究进展

肌萎缩侧索硬化（AmyotrophicLateralSclerosis,ALS）由Charot于1869年首先报道以来,至令其病因和发病机制尚不清楚。已提出的病因有遗传因素、环境因素、病毒感染及无疾因素等。近年来随着免疫学及分子生物学的迅速发展,ALS免疫学资料越来越多。现就本病的免疫学研究情况作一综述。     

散发性肌萎缩侧索硬化病人脑脊液中3-硝基酪氨酸水平增高

目的 探讨自由基氧化损伤在散发性肌萎缩侧索硬化的发病机制中有无作用. 方法 散发性肌萎缩侧索硬化病人15例,神经系统正常的外科手术腰麻病人20例,采集脑脊液后用高效液相色谱法进行检测分析.比较散发性肌萎缩侧索硬化病人和神经系统正常的受试者脑脊液中3-硝基酪氨酸、酪氨酸含量及3-硝基酪氨酸与酪氨酸比值.结果 散发性肌萎缩侧索硬化病人脑脊液中3-硝基酪氨酸含量及3-硝基酪氨酸与酪氨酸比值与对照组相比增高有显著性差异病人组与对照组脑脊液中3-硝基酪氨酸含量分别为(228.52±124.30) nmol/L和(112.86±47.10) nmol/L,P<0.01;两组的3-硝基酪氨酸与酪氨酸比值分别为(7.60±4.38)×10-3和(3.19±1.20) ×10-3,P<0.01.结论 由过硝酸根介导的自由基氧化损伤在散发性肌萎缩侧索硬化的发病机制中具有重要作用.     

PON3Ala99Ala基因多态性与散发性肌萎缩侧索硬化易感性关联研究

目的 探讨散发性肌萎缩侧索硬化(sALS)发病是否与对氧磷酶3 (PON3) Ala99Ala基因多态性相关。方法 应用聚合酶链式反应-限制性酶切片段长度多态性(PCR-RFLP)对117例健康对照和108例sALS患者进行PON3Ala99Ala基因多态性分析。结果 本研究中病例组与健康对照组人群PON3Ala99Ala基因多态性符合Hardy-Weinberg遗传平衡定律,具有代表性。sALS组与对照组之间PON3Ala99Ala基因的三种基因型分布比较无差异(P=0.157)。PON3Ala99Ala基因A和G等位基因分布在对照组、sALS组中进行组间比较,差异无统计学意义(P=0.257)。与AA基因型比较,AG基因型、GG基因型和AG+GG基因型均不增加患sALS的风险(分别为OR=1.68,95%CI=0.95～2.98;OR=0.63,95%CI=0.11～3.54;OR=1.55,95%CI=0.89～2.71)。结论 PON3Ala99Ala基因多态性不增加sALS发病易感性。     

Clarke's column in sporadic amyotrophic lateral sclerosis

Summary Histological, ultrastructural and morphometrical observations on Clarke's column were carried out in 18 patients with sporadic amyotrophic lateral sclerosis (ALS) and 15 age-matched control subjects. Of the 18 ALS patients 6 had been on a respirator before death. Bunina bodies were found in the neuronal cytoplasm in 7 of the 12 non-respirator-supported ALS patients and in 3 of the 6 respirator-supported patients. The number of spheroids was significantly higher in the non-respirator-supported patients (P<0.01) than in the control subjects; however, the number in the respirator-supported patients was about equal to that in the controls. The number of neurons in Clarke's column in the non-respirator-supported ALS patients was not reduced, but in the respirator-supported patients they tended to disappear with time after respiratory support. These findings suggest that Clarke's column neurons are also involved primarily in the disease process in sporadic ALS. However, they may begin to disappear only after the patients require respiratory support.Supported in part by a research grant for CNS degenerative diseases from the Ministry of Health and Welfare, Japan     

Patients with amyotrophic lateral sclerosis and cancer do not differ clinically from patients with sporadic amyotrophic lateral sclerosis

We examined whether patients with both amyotrophic lateral sclerosis (ALS) and cancer differ from classical ALS patients, and whether motor neuron disease responds to oncological therapy. We analyzed clinical and immunological features of 14 patients (9 men, 5 women; mean age 65.3 years) with pure/definite ALS and cancer. Patients with solid tumor cancer and definite ALS were selected according to the El Escorial criteria; cases with ALS plus were excluded. Four patients had breast cancer, three lung adenocarcinoma, and three bowel tumor; hepatocarcinoma, kidney cancer, and mesothelioma were observed in one case each, and in one patient the primary tumor was unidentified. Patients' sera were examined for antinervous system antibodies by means of immunohistochemistry and western blot analysis. Of five patients who underwent surgical therapy, two worsened during the procedure, while the other three had no benefit. The remaining two patients did not improve after chemotherapy and radiotherapy. In none of our cases did the oncological disease progress. Death was a consequence of ALS in all eight patients who died. Median survival was 18 months and did not differ from that of 28 ALS patients matched for age, sex, and onset features (bulbar or spinal). Anti-nervous system antibodies were never detected. We conclude that our group of pure ALS patients with cancer do not significantly differ from patients with classical ALS. They usually die as a consequence of the motor neuron syndrome in the absence of cancer progression. To date we have not observed any response of ALS to antitumor therapy. Received: 19 November 1999 / Received in revised form: 25 February 2000 / Accepted: 17 May 2000     

The intermediolateral nucleus in sporadic amyotrophic lateral sclerosis

Summary Histological and morphometrical observations of the intermediolateral nucleus (IML) at the levels of the upper and lower thoracic segments (T2 and T9) were carried out in 18 patients with sporadic amyotrophic lateral sclerosis (ALS) and 15 age-matched control subjects. Of the 18 ALS patients 6 had been on a respirator before death. No Bunina bodies were found in the IML neurons in either the ALS patients or the control subjects. Only a small number of spheroids were encountered rarely in the IML in both the patients and controls. The number of neurons in the IML in the non-respirator-supported ALS patients were reduced at T2, but well preserved at T9 compared with the control subjects. In the respirator-supported ALS patients, there was a marked reduction of IML neurons at both T2 and T9. Considering the absence of direct synaptic contacts with anterior horn cells, these neurons, without the formation of Bunina bodies, appeared to be involved primarily in the disease process in sporadic ALS.Supported in part by a research grant for CNS degenerative diseases from the Ministry of Health and Welfare, Japan     

散发性肌萎缩侧索硬化患者Senataxin基因的突变检测和分析

目的 探讨散发性肌萎缩侧索硬化(SAIS)患者Senataxin(SETX)基因突变特点.方法 采用聚合酶链反应(PCR)扩增60例SALS患者SETX基因的26个外显子,应用直接基因测序法筛查其突变和多态,同时与200名健康对照进行比较.结果 我们检出2个新的同义突变,分别为Asp844Asp(GAC→CAT)和Phe998Phe(TTC→TTT).尽管在200名健康对照中未检出这2个同义突变,但经过不同物种间的同源序列比对,发现这2个序列不是保守序列,提示它们不是致病性突变.除此之外,我们还检出了19个多态.结论 我们发现了SETX基因的2个同义突变和19个多态,进一步扩大了SETX基因的突变谱和多态谱.     

Red cell superoxide dismutase activity in sporadic amyotrophic lateral sclerosis

Specific biologic markers are not available for definitive diagnosis and monitoring of disease progression in sporadic amyotrophic lateral sclerosis (SALS). Oxidative stress plays a role in ALS pathogenesis. The purpose of this study was to determine the association between Cu/Zn superoxide dismutase (SOD1) activity, diagnosis and prognosis. The present study included 25 SALS patients (SALS group; age 51+/-12 years) and 10 healthy subjects (age 45+/-5 years) as a control group. Patients were divided into groups representing four levels of diagnostic certainty of ALS in accordance with the El Escorial Revisited criteria. The disease state was determined using the modified ALS health state scale of Riviere et al. (Arch Neurol 1998:55;526-8). Red-cell SOD1 activity was determined by spectrophotometry. SOD1 activity in red cells was compared statistically with diagnostic criteria and disease state. Red cell SOD1 activity was high in all SALS patients, but there was no significant association between enzyme activity and diagnostic criteria and disease state. In this preliminary study, we did not find any correlation between SOD1 activity level and diagnosis or prognosis. Measured SOD1 activity sometimes supports ALS diagnosis, but it is neither a specific nor a prognostic factor.     

Neurophysiological index is associated with the survival of patients with amyotrophic lateral sclerosis

ObjectiveTo investigate the association between Neurophysiological Index (NI) and the survival of patients with Amyotrophic Lateral Sclerosis (ALS).MethodsPatients diagnosed with ALS in the Department of Neurology, West China Hospital, Sichuan University from May 2015 to May 2017 were enrolled in this study, and then were followed up every 3 months until 31st May 2018. According to the mean NI values, the participants were categorized into high NI and low NI groups. Differences between groups were compared with parametric or non-parametric test, whichever was more appropriate. Kaplan-Meier method and Cox regression model were used to calculate the survival analysis.ResultsOne hundred and ninety one sporadic ALS patients including 78 female and 113 male were included in this study. Among them, 5 (2.6%) patients were lost to follow-up, 79 patients were still alive while 102 patients died at the last follow up. The median survival time from symptom onset to death was 33 months, as estimated by Kaplan-Meier analysis. ALS patients with lower NI exhibited to have shorter median survival time compared to the patients with high NI. Through multivariate Cox regression analysis, NI, the revised ALS functional rating scale (ALSFRS-R), diagnostic delay and age at disease onset were found to be associated with the survival of ALS patients.ConclusionOur findings indicate that NI provides a single number that seems to associate with the survival of ALS.SignificanceNI is readily available and reproducible, and it could be utilized as a potential biomarker for survival in further multicenter clinical trials in ALS.