结节性硬化症合并心脏横纹肌瘤15例临床分析

Clinical analysis of 15 pediatric patients with tuberous sclerosis complex complicated by cardiac rhabdomyomas

摘要:

目的 研究结节性硬化症(TSC)相关的心脏横纹肌瘤(CRM)的临床特点。方法 收集15例合并CRM的TSC患儿的临床资料, 分析其临床特征及基因突变结果。结果 11例(73%)患儿为多发CRM, 肿瘤绝大部分位于左右心室, 在心脏彩超上显示多数呈类圆形强回声团, 边界清晰。3例患儿出现心律失常, 2例发生心力衰竭。2例患儿行基因检测, 均检测到TSC基因致病性突变, 分别为TSC1基因和TSC2基因突变。随访3例患儿(随访时间6个月~3年2个月), 其CRM均自发缩小或消退。结论 TSC患儿合并CRM多为多发, 部分患儿可出现心力衰竭及心律失常。心脏彩超是发现CRM的重要方法。CRM可能有自然消退的倾向。TSC基因检测可在分子遗传学上确诊TSC。

Abstract:

Objective To investigate the clinical features in children with tuberous sclerosis complex (TSC)-associated cardiac rhabdomyomas (CRM). Methods The clinical data of 15 children with TSC complicated by CRM were collected. The clinical features of the patients were analyzed, and TSC gene mutations were detected. Results Eleven cases (73%) developed multiple CRM. The majority of the tumors were located in the left and right ventricles. Most tumors presented as a round-like hyperechogenic mass with a clear margin on echocardiography. Arrhythmias occurred in 3 patients and 2 patients experienced heart failure. Gene mutation tests were performed in 2 patients, and pathogenic mutations were detected in both patients, which were TSC1 mutation and TSC2 mutation, respectively. Three patients were followed up for 6 to 38 months, and their CRM shrank or regressed spontaneously. Conclusions TSC-associated CRM is generally multiple. Heart failure and arrhythmias may occur in some patients. Echocardiography is important for diagnosis of CRM. TSC-associated CRM has an inclination to spontaneous regression. TSC can be diagnosed at a molecular genetic level by TSC gene mutation detection.