早发性癫痫脑病男性患儿ARX基因突变及其临床特点  

ARX gene mutation and clinical characteristics in male patients with early-onset epileptic encephalopathy

作　　者：赵滢[1] 章清萍[1] 张晓英[1] 包新华[1] 吴希如[1] 

机构地区：[1]北京大学第一医院,北京100034

出　　处：《山东医药》2014年第23期13-15,19,共4页Shandong Medical Journal

基　　金：首都特色应用研究项目(Z121107001012049);北京大学"985工程"三期临床医院合作专项项目

摘　　要：目的探讨早发性癫痫脑病男性患儿ARX基因突变及其临床表型特点。方法收集42例男性早发性癫痫脑病患儿详细的临床资料,采集患儿及家长外周血,应用PCR、直接测序和多重连接依赖的探针扩增(MLPA)技术对ARX基因第二外显子进行突变分析。对患儿的临床表型特点进行分析。结果 42例早发性癫痫脑病患儿中3例患儿存在ARX基因第二外显子大片段缺失,检出率为7.14%(3/42)。其中1例为非特异性癫痫脑病,2例为婴儿痉挛症。3例患儿均于出生后6个月内出现难以控制的癫痫发作,2例患儿在脑电监测中发现高度失律,3例患儿对多种抗癫痫手段反应差,且均表现为严重的智力运动发育落后或倒退。未检出缺失的39例患儿发作形式呈现更多样化的特点,其中5例患儿大运动发育基本正常,3例患儿对ACTH或生酮饮食手段控制癫痫有效。结论早发性癫痫脑病患儿中部分存在ARX基因第二外显子大片段缺失。具有ARX基因突变的早发性癫痫脑病患儿,其临床表现为6个月内出现难治性癫痫发作,以部分性发作及痉挛发作为主,同时有显著的智力运动发育落后、甚至倒退;少数未检出缺失的患儿的大运动发育可基本正常,对ACTH或生酮饮食反应良好。Objective To explore the ARX gene mutation and clinical phenotypic characteristics in male patients with early-onset epileptic encephalopathy .Methods Detailed clinical information and the peripheral blood of 42 male children with early-onset epileptic encephalopathies and their parents were collected .Exon 2 of ARX gene mutation was screened u-sing PCR-DNA sequencing and multiple ligation-dependent probe amplification （ MLPA） , and the clinical phenotypic char-acteristics were also analyzed .Results Among 42 cases, large deletions of exon 2 for ARX gene can be detected in 3 ca-ses, and the overall mutation rate was 7.14%（3/42）.One of the 3 patients was diagnosed as non-specific epileptic en-cephalopathies , the other two were diagnosed as infantile spasm;all 3 patients were attacked by intractable seizures occur-ring in the first six months of life .Two patients presented hypsarrhythmia in the EEG records .All 3 patients were resistant to multiple AEDs and presented severe psychomotor developmental delay or regression .Various seizure types were observed in 39 patients without large deletions of exon 2 for ARX;among them, 5 patients acquired nearly normal gross motor devel-opment, ACTH and ketogenic diet were effective for controlling seizures in 3 patients.Conclusions A part of children with early-onset epileptic encephalopathy have large deletion of exon 2 in ARX gene.Early-onset epileptic encephalopathy children with large deletion of exon 2 in ARX gene present intractable seizures during six months of life , partial seizures and spasms are the most common seizure types .Meanwhile , they are characterized by severe psychomotor developmental delay even regression .Few patients without deletions could acquire nearly normal developmental milestones and respond well to ACTH or ketogenic diet .

关 键 词：早发性癫痫脑病 ARX基因 基因突变 表型 

分 类 号：R742.1[医药卫生—神经病学与精神病学]