一例以多发性骨破坏为显著特征的老年戈谢病的诊疗和基因检测分析  

Diagnosis,treatment and genetic analysis of an elderly patient with Gaucher’s disease characterized by marked multiple bone destruction

作　　者：秦姝超 尹华 王蓉[1] 朱飞鹏 李建勇[1] 卢瑞南[1] Shuchao Qin;Hua Yin;Rong Wang;Feipeng Zhu;Jianyong Li;Ruinan Lu(Department of Hematology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,First Afliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029 [2]南京医科大学第一附属医院,江苏省人民医院放射科,南京210029

出　　处：《遗传》2023年第3期261-269,共9页Hereditas（Beijing)

基　　金：国家自然科学基金项目(编号:817900167);江苏省自然科学基金项目(编号:BK20191060)资助。

摘　　要：戈谢病(Gaucher’s disease)是一种罕见的常染色体隐性遗传病,由于葡萄糖脑苷脂酶(glucocerebrosidase,GBA)基因突变导致溶酶体中GBA活性降低或缺乏,造成其底物葡萄糖脑苷脂在溶酶体中贮积,产生肝、脾、肾、骨、造血系统甚至神经系统受累的临床表现。本文报道1例以多发性骨破坏为显著特征的老年患者,伴有幼年脾切除及“骨髓炎”病史,呈现肝脏显著增大、贫血、血小板减少及骨量减少等症状。临床检测显示,患者外周血GBA活性降低、葡糖鞘氨醇水平以及壳三糖酶活性显著升高;基因检测结果表明,患者GBA基因发生纯合错义突变NM_001005741.2 c.770A>G(p.Asp257Gly)。经过6个月的酶替代治疗,患者血小板恢复正常、贫血改善、肝脏体积有所缩小。进一步检测发现患者母亲、长兄、次兄均存在该位点的杂合突变,符合孟德尔遗传规律。虽然患者Asp257Gly变异在已知的GBA基因变异库中未被报道,但无论是临床表现还是酶学及生物标记物特征,以及酶替代治疗的效果,均支持戈谢病的诊断,推断患者Asp257Gly纯合变异为临床致病性变异。本病例发现的新突变位点丰富了GBA基因的遗传变异数据库,同时本病例的诊治过程也为该类患者的早期识别并诊断以及尽早治疗提供了借鉴与参考。Gaucher’s disease is a rare autosomal recessive genetic disease.Due to the decrease or lack of glucocerebrosidase(GBA)activity in lysosome caused by the mutation of GBA gene,its substrate glucocerebroside is detained in lysosome,resulting in clinical manifestations of liver,spleen,kidney,bone,hematopoietic system and even nervous system involvement.Here,we report a case of elderly patient presenting marked multiple bone destruction,with childhood medical history of splenectomy and“osteomyelitis”.The patient has a significantly enlarged liver,accompanied by anemia,thrombocytopenia and osteopenia.Laboratory studies show this patient has low blood GBA activity and high glucosyl sphingosine level and increased chitotriosidase activity.Genetic testing revealed a homozygous missense variant NM_001005741.2 c.770A>G(p.Asp257Gly)in the patient’s GBA gene.After 6 months of enzyme replacement therapy,the patient’s platelets returned to normal,anemia improved,and liver volume decreased.Further detections show that the mother and brothers of the patient have heterozygous mutations at this locus,which is consistent with Mendelian inheritance law.Although this variant has not been reported in literatures or database,both clinical manifestations,characteristics of enzymology and biomarkers,and the effect of enzyme replacement therapy support the diagnosis of Gaucher’s disease.The Asp257Gly variant is therefore assessed as a clinical pathogenic variant.This study expands the spectrum of the GBA gene variants.The diagnosis and treatment process of this case also provide reference for the early identification,diagnosis and early treatment of this kind of patients.

关 键 词：戈谢病 多发骨破坏 老年 葡萄糖脑苷脂酶基因 

分 类 号：R596.1[医药卫生—内科学]