北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (5): 691-697.

• 论著 • 上一篇    下一篇

RYR1热点突变筛查在先天性肌病诊断中的应用

常杏芝1,金怡汶1,王静敏1, 袁云2,熊晖1, 王爽1,秦炯1△   

  1. (北京大学第一医院 1.儿科,2.神经内科,北京100034)
  • 出版日期:2014-10-18 发布日期:2014-10-18

Hot spot mutation screening of RYR1 gene in diagnosis of congenital myopathies

CHANG Xing-zhi1, JIN Yi-wen1, WANG Jing-min1, YUAN Yun2, XIONG Hui1, WANG Shuang1, QIN Jiong1△   

  1. (1.Department of Pediatrics, 2. Department of Neurology, Peking University First Hospital, Beijing 100034, China)
  • Online:2014-10-18 Published:2014-10-18

摘要: 目的:先天性肌病是一组具有类似临床表现的肌肉病,通过对15例不同类型先天性肌病患者进行RYR1基因热点突变检测,探讨RYR1基因热点突变检测在先天性肌病诊断中的价值。方法:收集患者的临床资料,包括临床表现和体征、肌酸激酶测定、肌电图检测及肌肉活检病理诊断,提取患者静脉血淋巴细胞DNA,对RYR1基因C端96-106号外显子进行突变检测。结果:所有患者生后运动发育里程碑均有不同程度落后,均存在行走不稳、易跌倒、不会跑跳等症状,病情无进行性加重。体格检查提示所有患儿均存在不同程度的肌力和肌张力减低、肌容积缩小、腱反射减弱、病理征(-),其中3例患者存在高腭弓。血清肌酸激酶轻度升高3例,正常12例。肌电图提示肌源性损伤11例,未见异常4例。肌肉活检病理诊断中央轴空病3例,中央核肌病2例,先天性肌型比例失调2例,杆状体肌病3例,多微小轴空病1例,轻微肌肉病样病理改变3例;根据阳性家族史和基因检查确诊中央轴空病1例。RYR1基因热点突变筛查在其中一个常染色体显性遗传的中央轴空病家系中发现位于102号外显子的c.14678 G>A (p.Arg4893Gln) 突变,为文献已经报道的致病突变;在2例散发的中央轴空病患者发现新发突变,分别是位于101号外显子的c.14596 A>G (p.Lys4866Gln)突变及102号外显子的c.14719 G>A (p.Gly4907Ser)突变,其中1例患儿的无症状父亲发现相同的突变;在其他先天性肌病患者中,均未发现RYR1基因C端(96-106号外显子)存在异常突变。结论:不同病理类型的先天性肌病患者具有类似的临床症状和体征、相似的肌酶测定与肌电图改变,活检病理对选择进一步的基因检查具有重要指导作用。本组RYR1基因C端热点突变仅见于中央轴空病患者,对于临床高度疑诊者可首先考虑该基因型的热点筛查。

关键词: 肌病, 结构性, 先天性, 兰尼碱受体钙释放通道, 突变

Abstract: Objective:To detect hot spot mutation of RYR1 gene in 15 cases of congenital myopathy with different subtypes, and to discuss the value of RYR1 gene hot spot mutation detection in the diagnosis of the disease.Methods: Clinical data were collected in all the patients, including clinical manifestations and signs, serum creatine kinase, electromyography. Fourteen of the patients accepted the muscle biopsy. Hot spot mutation in the C-terminal of RYR1 gene (extron 96-106) had been detected in all the 15 patients. Results: All the patients presented with motor development delay, and they could walk at the age of 1 to 3.5 years,but were always easy to fall and could not run or jump. There were no progressive deteriorations. Physical examination showed different degrees of muscle weakness and hypotonia.High arched palates were noted in 3 patients. The serum levels of creatine kinase were mildly elevated in 3 cases, and normal in 12 cases. Electromyography showed “myogenic” features in 11 patients, being normal in the other 4 patients. Muscle biopsy pathologic diagnosis was the central core disease in 3 patients, the central nuclei in 2 patients, the congenital fiber type disproportion in 2 patients, the nameline myopathy in 3 patient, the multiminicore disease in 1 patient, and nonspecific minimal changes in the other 3 patients; one patient was diagnosed with central core disease according to positive family history and gene mutation. In the family case (Patient 2) of central core disease, the c.14678G>A (p.Arg4893Gln) mutation in 102 extron of RYR1 was identified in three members of the family, which had been reported to be a pathogenic mutation. The c.14596A>G(p.Lys4866Gln) mutation in 101 extron was found in one patient with central core disease(Patient 1), and the c.14719G>A(p.Gly4907Ser) mutation in 102 extron was found in another case of the central core disease(Patient 3).The same novel mutation was verified in one of the patients’ (Patient 3) asymptomatic father.Conclusion: Congenital myopathies in the different subtype have the similar clinical manifestations, signs, enzyme detection and electromyography changes. Muscle biopsy plays an important role in the selection of genes to be detected. Hot spot mutation in C-terminal of the RYR1 gene can only be identified in patients with central core disease, so we suggest this hot spot gene mutation screening apply to the suspicious patient with central core disease only.

Key words: Myopathies, structural, congenital, Ryanodine receptor calcium release channel, Mutation

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