Stankiewicz-Isidor综合征一例基因型及临床表型分析并文献复习
Genotype and clinical phenotype analysis of a case of Stankiewicz-Isidor syndrome and literature review
Received date: 2022-03-15
Online published: 2023-07-06
目的: 分析1例Stankiewicz-Isidor综合征(Stankiewicz-Isidor syndrome,STISS)男童的临床特征及检查结果,并结合文献复习,为特殊类型矮小症的诊治提供参考。方法: 1例因“生长发育落后4年伴面部畸形和视力异常”就诊的4岁男童,对其进行详细的病史采集及体格检查,行生长激素激发试验、胰岛素样生长因子1、甲状腺功能等检测以及相关影像学检查。采用第二代目标区域捕获高通量测序技术对患儿及其父母进行全外显子检测,并对可疑基因变异位点进行Sanger测序验证。结合文献分析STISS患儿临床表型与基因型的特点。结果: 该例患儿存在生长发育迟缓、视力障碍,伴低耳位、下颌后缩和小颌畸形特殊面容;全外显子测序发现PSMD12基因1个杂合移码变异c.1118delinsCC:p.Ile373ThrfsTer15,而受检者父母均未携带该变异。根据美国医学遗传学与基因组学学会(American College of Medical Genetics and Genomics,ACMG)指南,评判该变异为致病性变异,且为新发变异,结合患儿基因型和临床表型诊断为STISS。检索数据库(中国知网、万方数据库、PubMed),获得46例STISS患者,加上本例患者共47例。分析发现,89.4%(42/47)存在生长发育障碍,85.1%(40/47)存在面部畸形,70.2%(33/47)存在智力障碍,但脑影像学异常以及皮肤表现异常则较少见。47例患者中,13例存在PSMD12基因缺失,34例存在单碱基位点变异。结论: 本文报道的STISS患儿为PSMD12基因变异导致,该变异为新发变异,且数据库内未见此类变异报道;该患儿存在生长发育障碍、面部畸形等常见临床表型,但不同基因型患者的临床表型存在异质性。
关键词: Stankiewicz-Isidor综合征; PSMD12基因; 基因型; 临床表型
张雪蕾, 何亲羽, 张习雯, 陈立芬, 董治亚 . Stankiewicz-Isidor综合征一例基因型及临床表型分析并文献复习[J]. 诊断学理论与实践, 2023 , 22(01) : 58 -63 . DOI: 10.16150/j.1671-2870.2023.01.009
Objective: To analyze the clinical characteristics and examination results of a child with Stankiewicz-Isidor syndrome (STISS), and to provide reference for the diagnosis and treatment of special types of short stature. Methods: A 4-year-old boy with “4 years of developmental delay with craniofacial abnomality and ophthalmological malformation” was recruited,and detailed medical history were collected. Physical examination, laboratory detection [growth hormone stimulation test, insulin-like growth factor 1( IGF-1), thyroid function and other tests] and imaging examinations were performed. Whole-exome sequencing(WES) was used to detect suspicious mutation sites in children and their parents with se-cond-generation target region capture high-throughput sequencing technology, and the findings were verified by Sanger sequencing. The phenotypes and genotype of the STISS children were analyzed in combination with cases reported in literature reported in PubMed, China National Knowledge Internet(CNKI) and WANFANG DATA. Results: The child presented growth retardation, visual impairment, low ear position, mandibular recession, and special facial features of micrognathia. WES revealed a novel heterozygous frameshift variant c.1118delinsCC:p.Ile373ThrfsTer15 in the PSMD12 gene. According to ACMG guidelines, this was a pathogenic variant, which led to STISS.A total of 46 patients with STISS reported pre-viously,and thus there were 47 cases to be analyzed. It indicated that 89.4%(42/47) had growth and development disorders, 85.1%(40/47) had facial deformities, 70.2%(33/47) had intellectual disabilities, while brain imaging abnormalities and skin manifestations were rare.In 47 patients, 13 cases had PSMD12 gene deletion and 34 cases carried single base site mutations in PSMD12 gene. Conclusions: The STISS reported in this article is caused by a novel variation in PSMD12 gene. The child has common clinical phenotypes such as growth and development disorders and facial deformities, but the clinical phenotypes in patients with different genotypes are heterogeneous.
Key words: Stankiewicz-Isidor syndrome; PSMD12 gene; Genotype; Clinical phenotype
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