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中华妇幼临床医学杂志(电子版) ›› 2014, Vol. 10 ›› Issue (03) : 343 -347. doi: 10.3877/cma.j.issn.1673-5250.2014.03.016

所属专题: 文献

论著

白细胞介素-2受体共同γ链基因突变致X-连锁重症联合免疫缺陷病的临床分析
刘钋宁1, 李虹1, 李强1,*,*()   
  1. 1. 610041 成都,四川大学华西第二医院小儿血液科
  • 收稿日期:2014-03-14 修回日期:2014-05-04 出版日期:2014-06-01
  • 通信作者: 李强

Gene Mutation of Interleukin-2 Receptor Common Gamma Chain in Four Male Infants with X-Linked Severe Combined Immunodeficiency

Poning Liu1, Hong Li1, Qiang Li1()   

  1. 1. Department of Pediatric Hematology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2014-03-14 Revised:2014-05-04 Published:2014-06-01
  • Corresponding author: Qiang Li
  • About author:
    (Corresponding author: Li Qiang, Email: )
引用本文:

刘钋宁, 李虹, 李强. 白细胞介素-2受体共同γ链基因突变致X-连锁重症联合免疫缺陷病的临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2014, 10(03): 343-347.

Poning Liu, Hong Li, Qiang Li. Gene Mutation of Interleukin-2 Receptor Common Gamma Chain in Four Male Infants with X-Linked Severe Combined Immunodeficiency[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(03): 343-347.

目的

分析白细胞介素-2受体共同γ链(IL-2RG)基因突变致X-连锁重症联合免疫缺陷病(SCID)的临床特征与基因突变情况。

方法

选取2010年5月至2012年9月四川大学华西第二医院收治的4例疑似X-连锁SCID患儿为研究对象(本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并征得受试对象监护人的知情同意,与之签署临床研究知情同意书)。对4例患儿及其亲属进行IL-2RG基因突变检测。

结果

本研究4例患儿均合并严重肺部感染(重症肺炎)且胸部X射线摄片均提示无胸腺或胸腺显著缩小(100%),其中,接种卡介苗后出现结核分枝杆菌感染患儿为3例(75%),有家族病史患儿为2例(50%)。4例患儿中,血常规示淋巴细胞绝对计数均减少(100%)。IL-2RG基因突变检测结果示4例(100%)患儿均有基因突变并确诊为X-连锁SCID,其中,无义突变为2例(50%,分别为c.711.G>A,p.W237X及c.578.G>A,p.W193X),错义突变为1例(25%,c.173C>A, p.P58Q),剪切位点突变为1例(25%,IVS5-2 G>T)。4例患儿直系亲属及1例患儿母系亲属IL-2RG基因突变检测结果显示,有家族携带者患儿为3例(75%),新生突变为1例(25%)。

结论

IL-2RG基因突变检测可诊断X-连锁SCID。X-连锁SCID患儿若能尽早进行IL-2RG基因检测并明确诊断,并在患儿发生危及生命的感染前及时采用造血干细胞移植或骨髓移植治疗,可重建患儿免疫系统,挽救其生命,显著提高生存率。

Objective

To analyse the relationship between clinical manifestations and the mutation of interleukin-2 receptor common gamma chain (IL-2RG) mutation of X-linked severe combined immunodeficiency (SCID) caused by IL-2RG.

Methods

From May 2010 to September 2012, four boys who were clinically suspected as X-linked SCID were enrolled in this study. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University.Informed consent was obtained from each participants' parents. IL-2RG mutation were detected and analyzed in four patients and their family members.

Results

Four boys were all suffered by severe pulmonary infection (severe pneumonia) and demonstrated to have absence of thymus or dysplastic thymus by chest X-ray film. Among them, three patients had tuberculosis infection after bacilli Calmette-Guerin (BCG) vaccination (75%), two patients had family history (50%), and all patients suffered lymphopenia (100%). All 4 male infants were demonstrated to be X-linked SCID due to the mutation of IL-2RG, including 2 patients with nonsense mutations (50%, c. 711.G>A, p. W237X and c. 578.G>A, p. W193X, respectively), one missense mutation (25%, c. 173C>A, p. P58Q), and 1 splice site mutation (25%, IVS5-2 G>T). The linear relatives of 3 patients and maternal relatives were detected the mutation of IL-2RG, and 3 patients were demonstrated to have family carriers (75%) and one patient was suffered by de novo mutation (25%).

Conclusions

The detection of IL-2RG gene mutation can confirm clinical diagnosis of X-linked SCID which is critical for patients to take hematopoietic stem cell transplantation as soon as possible to reconstruction of immunity before the fatal infection occurred. The early immune reconstruction can offer the best chance of long term survival.

表1 4例患儿的临床特征
Table 1 Clinical characterizations of four infants with X-linked SCID
表2 4例患儿血常规检测结果(×109/L)
Table 2 Results of complete blood count of four infants with X-linked SCID(×109/L)
表3 4例患儿免疫学检测结果(%)
Table 3 Results of immunology detection of four infants with X-linked SCID(%)
表4 4例患儿IL-2RG基因突变测定结果
Table 3 The gene mutations of IL-2RG of four infants with X-SCID
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