ZASP基因突变所致肌原纤维病一家系报道及文献复习  

Case Report of A Family with Myofi brillar Myopathy Caused by ZASP Gene Mutation and Literature Review

作　　者：陈阳[1] 奚剑英[1] 罗苏珊[1] 卢家红[1] 赵重波[1] CHEN Yang XI Jian-ying LUO Su-shan LU Jia-hong ZHAO Chong-bo(Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, Chin)

机构地区：[1]复旦大学附属华山医院神经内科,200040

出　　处：《中国临床神经科学》2016年第6期613-620,共8页Chinese Journal of Clinical Neurosciences

基　　金：上海市卫计委重点项目(编号:201440019);上海市卫计委青年项目(编号:20154Y0004);上海市科委重点项目(编号:15DZ1208002)

摘　　要：目的通过对ZASP基因突变所致肌原纤维病一家系报道及文献复习,了解该病的临床、病理及基因突变特点。方法分析1例远端肌病患者的临床、肌肉MRI及肌肉病理特点,并追踪其家系家族史。先证者外周血提取DNA,进行目标区序列捕获二代测序(含58个肌病相关基因),明确存在ZASP基因变异。对家系其他成员进行Sanger测序进一步明确及验证突变位点。结果先证者为中年女性,52岁起病,表现为进行性双下肢无力伴双腿变细。先证者家系2代15名中,除先证者外共6名存在肌肉受累,4名为先证者同代亲属,临床特点与先证者类似;2名为先证者下一代亲属,其中1名仅有闭目肌受累及肌酸激酶(CK)轻度升高(291 U·L-1),另1名仅有CK轻度升高(199 U·L-1)。先证者肌肉病理发现肌细胞内有异常嗜伊红物质沉积和镶边空泡形成,免疫组化染色可见肌纤维内desmin蛋白沉积。电镜下可见Z线附近致密颗粒沉积。目标区序列捕获二代测序及Sanger测序确定该家系致病基因为ZASP基因已报道错义突变p.A147T(c.G439A)。结论 ZASP基因突变所致的肌原纤维病家系为国内首次报道。Aim To explore the clinical, pathological genetic findings of a family with Z-disc alternatively spliced PDZ-domain containing protein（ZASP） myopathy. Methods The clinical features, muscle MRI presents and pathological fi ndings of a family with distal myopathy was analyzed. Genomic DNA of the proband was extracted from peripheral blood and the next generation sequencing of target gene（including 58 myopathy genes） was performed to explore the mutation of ZASP gene. Sanger sequencing was performed in other members of the family to identify the mutation. Results The proband was a middle age woman and she suffered progressive lower limbs weakness and atrophy at her age of 52 years old. And there were six other members suffered involvement of muscles out of 15 relatives in two generations. Fourof them were the same generation of the proband and the clinical presents and physical exam features of them were similar to the proband. Two of them were the next generation of the proband and one of these two relatives suffered eye closure weakness. The other one just had a slightly higher CK level（199 U·L^（-1）） without any symptom. Pathologically, rimmed vacuoles and alkaline substances were seen in the muscle fi bers. The deposited material were positive for desmin. Dense matter deposition could be found around Z disc. ZASP gene sequencing found a reported mutation, A147T（c.G439A）. Conclusion This was the fi rst case report of ZASP gene myopathy family in China.

关 键 词：远端肌病 肌原纤维病 Z盘选择性剪接PDZ蛋白肌病 ZASP基因 

分 类 号：R746[医药卫生—神经病学与精神病学]