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浙江大学学报(医学版)  2021, Vol. 50 Issue (4): 494-499    DOI: 10.3724/zdxbyxb-2021-0268
专题报道     
五例Keishi-Bukuryo-Gan综合征患儿临床及遗传学特征分析
王诗琦(),卫海燕(),付东霞,刘晓景,沈凌花,毋盛楠,陈永兴
郑州大学附属儿童医院河南省儿童医院 郑州儿童医院内分泌遗传代谢科,河南?郑州 450018
Clinical and genetic characteristics of Keishi-Bukuryo-Gan syndrome: an analysis of 5 cases
WANG Shiqi(),WEI Haiyan(),FU Dongxia,LIU Xiaojing,SHEN Linghua,WU Shengnan,CHEN Yongxing
Department of Endocrinology, Genetics and Metabolism, Children’s Hospital Affiliated of Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou 450018, China
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摘要:

目的:分析5例Keishi-Bukuryo-Gan综合征(KBG综合征)患儿的临床及遗传学特征,以提高临床医生对该罕见遗传性疾病的诊治能力。方法:回顾性分析郑州大学附属儿童医院2018年11月至2020年9月收治的5例KBG综合征患儿,对其临床特征、基因突变及治疗结果进行归纳总结。结果:5例患儿均为男性,来自4个家系,5例均有三角脸、浓眉、薄上唇、前囟大或闭合延迟、骨骼发育异常;4例有生长发育迟缓、大耳、耳唇厚等表现;3例有中切牙大;2例伴先天性心脏病;2例存在皮肤改变;2例存在生殖器改变;2例出现性格异常。所有患儿肝肾功能、甲状腺功能、血气分析、电解质等均在正常范围;行骨龄检查的3例患儿均显示存在不同程度落后;2例头颅磁共振成像显示为白质髓鞘化落后。全外显子组测序检出5例患儿均存在ANKRD11基因杂合突变,其中c.6836_6837delTG、c.5866C>T、c.6270delT为新发突变位点。所有患儿的父母均未发现携带突变。2例患儿应用重组人生长激素治疗后实现身高追赶及认知能力的提高。结论:KBG综合征表型谱广,前囟大或闭合延迟、耳大耳唇厚可能是该病婴幼儿期的主要表现,ANKRD11基因突变多为自发突变,早期应用生长激素治疗可实现身高追赶及认知能力提高,且无明显不良反应。

关键词: 遗传性疾病,先天性Keishi-Bukuryo-Gan综合征ANKRD11基因表型发育迟缓重组人生长激素    
Abstract:

Objective: To analyze the clinical and genetic characteristics of children with Keishi-Bukuryo-Gan (KBG) syndrome. Methods:The clinical and genetic data of 5 children with KBG syndrome admitted in Children’s Hospital Affiliated of Zhengzhou University from November 2018 to September 2020 were retrospectively analyzed. Results:Five children were all males who came from four different families. All children presented triangular face, bushy eyebrows, thin upper lip, large or delayed closure of anterior fontanel, and abnormal bone development. Four cases had growth retardation, large ears, thick ear lips; 3 cases had large central incisors; 2 cases had congenital heart disease; 2 cases had abnormal skin changes; 2 cases had genital changes; and 2 cases became grumpy. Liver and kidney function,thyroid function, blood gas analysis and electrolyte of the children were all in the normal range. Three children received bone age examination, and all showed bone age lag. Two cases showed backward myelination of white matter in MRI. Whole exome sequencing revealed that all 5 children had heterozygous mutations in theANKRD11 gene, among which c.6836_6837delTG, c.5866C>T, and c.6270delT were newly discovered mutation sites. None of the parents of probands were found to carry the mutations inANKRD11 gene. Two cases achieved height catch-up and cognitive improvement after treatment with recombinant human growth hormone. Conclusion: KBG syndrome is characterized by a wide spectrum of phenotypes, and large or delayed closure of the anterior fontanel, large ears and thick ear lips may be the main manifestations of the disease in infants and young children. ANKRD11 gene mostly presents spontaneous mutations, and early application of growth hormone therapy can achieve height catch-up and cognitive improvement without obvious adverse reactions.

Key words: Genetic diseases,    inborn    Keishi-Bukuryo-Gan syndrome    ANKRD11 gene    Phenotype    Growth retardation    Recombinant human growth hormone
收稿日期: 2021-05-03 出版日期: 2021-11-01
CLC:  R596  
通讯作者: 卫海燕     E-mail: wangshiqi618@163.com;haiyanwei2009@163.com
作者简介: 王诗琦,住院医师,主要从事内分泌遗传代谢病研究;E-mail:wangshiqi618@163.com;https://orcid.org/0000-0002-2213-0944
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引用本文:

王诗琦,卫海燕,付东霞,刘晓景,沈凌花,毋盛楠,陈永兴. 五例Keishi-Bukuryo-Gan综合征患儿临床及遗传学特征分析[J]. 浙江大学学报(医学版), 2021, 50(4): 494-499.

WANG Shiqi,WEI Haiyan,FU Dongxia,LIU Xiaojing,SHEN Linghua,WU Shengnan,CHEN Yongxing. Clinical and genetic characteristics of Keishi-Bukuryo-Gan syndrome: an analysis of 5 cases. J Zhejiang Univ (Med Sci), 2021, 50(4): 494-499.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0268        http://www.zjujournals.com/med/CN/Y2021/V50/I4/494

图 1  KBG综合征患儿骨骼发育异常表现A、B:足弓塌陷,足外旋内翻;C:小足跟;D、E:小指短小,侧弯.
图 2  KBG综合征患儿耳廓发育异常表现A~D:耳廓大,耳唇厚、耳廓向前向外旋转;E:外耳廓发育不良、耳唇薄.
图 3  KBG综合征患儿皮肤改变A:面部白斑;B:背部蒙古斑.
图 4  5例KBG患儿身高增长曲线图身高百分位数据参考文献.

例序

出生

初诊

末次随访

身高(cm)

体重(kg)

年龄(岁)

身高(cm)

体重(kg)

发育商

年龄(岁)

身高(cm)

体重(kg)

发育商

1

50

2.80

2.2

80.5

10.0

60

4.3

102.5

15.7

71

2

50

3.20

2.0

83.0

9.1

45

3.3

97.7

10.5

60

3

43

2.40

2.2

79.5

9.5

72

3.5

83.6

11.5

75

4

1.35

1.0

71.0

8.5

52

1.7

76.8

9.6

56

5

41

2.10

1.1

73.5

9.6

55

1.7

79.3

10.0

61

表 1  5例KBG患儿生长发育情况
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