男性幼儿体检发现转氨酶升高——发现肝豆状核变性两处新的错义突变

A young boy with elevated aminotransferases in physical examination —Two novel missense mutations associated with Wilson's disease were found

摘要:

1 例3 岁男性患儿因体检发现肝功能异常5 个月入院。患儿无厌食、纳差、黄疸等症状,生长发育正常,肝脾无肿大,实验室检查常规筛查铜蓝蛋白水平(35 mg/L)明显降低,其余嗜肝病毒及巨细胞病毒、EB病毒均为阴性。肌酶正常,血糖、血氨及代谢筛查正常,自身免疫肝病抗体阴性。进一步行眼科检查示K-F 环阴性,24 h 尿铜水平0.56 μmol/L(正常)。对患儿、患儿父母及其妹妹进行ATP7B 基因检测,明确患儿和其妹妹具有两处新发现错义突变,为Exon7 杂合突变c.2075T>C, p.L692P 和Exon13 杂合突变c.3044T>C, p.L1015P,各来自父母双方,符合复合杂合突变,基因诊断肝豆状核变性(Wilson)病成立。患儿及其妹妹确诊Wilson 病后被嘱低铜饮食,患儿给予青霉胺驱铜治疗及锌剂拮抗铜吸收,其妹妹因尚无临床症状,故给予锌剂治疗。患儿经上述治疗3 个月后复查肝功能完全正常。

Abstract:

A 3-year-old boy had abnormal liver function, which was found in physical examination, for 5 months before admission. He had no symptoms such as anorexia, poor appetite, and jaundice, had normal growth and development, and showed no hepatosplenomegaly. Laboratory examination revealed significantly reduced ceruloplasmin (35 mg/L), as well as negative hepatotropic virus, cytomegalovirus, and Epstein-Barr virus. There were normal muscle enzymes, blood glucose, and blood ammonia and negative liver-specific autoantibodies. The boy had negative K-F ring and normal 24-hour urine copper (0.56 μmol/L). The ATP7B gene testing for the boy, his sister, and their parents detected two novel missense mutations in the boy and his sister, i.e., compound heterozygous mutations in exon 7 (c.2075T>C, p.L692P) and exon 13 (c.3044T>C, p.L1015P), which were inherited from their father and mother, respectively. Wilson's disease was confirmed by genetic diagnosis in the boy and his sister. The boy and his sister were given a low-copper diet. The boy was administered with penicillamine for decoppering and zinc supplement against copper uptake. His sister received zinc supplement alone because no clinical symptoms were observed. The boy showed normal liver function in the reexamination after 3 months of treatment.