甲基丙二酸尿症合并同型半胱氨酸血症心血管系统受累10例临床分析及随访

Clinical analysis and follow-up study of cardiavascular system involvement in 10 children with methylmalonic aciduria combined with hyperhomocysteinemia

摘要:

目的 探讨甲基丙二酸尿症合并同型半胱氨酸血症(简称合并型MMA)患儿存在心血管系统受累的临床特点及预后。方法 回顾性分析10 例合并型MMA 存在心血管系统受累患儿的临床资料,并对其转归进行随访。结果 10 例患儿中,4 例以气促、呼吸困难等心血管系统症状首发,3 例以水肿、血尿、蛋白尿等泌尿系统症状首发,3 例以发育落后、抽搐等神经系统症状首发。10 例患儿存在不同类型、不同严重程度的心血管系统损害。经过3 个月至8 年的治疗和随访,2 例先天性心脏病缺损自然闭合;1 例心律失常患儿无明显变化;5 例高血压患儿中,1 例失访,3 例血压已正常;5 例肺动脉高压患儿中,2 例死亡,2 例肺动脉压力恢复正常,1 例肺动脉压力仍轻度升高。7 例进行了MMACHC 基因检测,5 例存在c.80A>G突变。结论 对于以气促、呼吸困难起病的不明原因肺动脉高压和高血压患儿应注意代谢性疾病的可能。心血管系统受累的严重程度可能是影响合并型MMA 预后的重要原因。患儿心血管系统受累可能主要与MMACHC 基因c.80A>G 突变相关。

Abstract:

Objective To study the clinical features and treatment outcomes of cardiovascular system involvement in children with methylmalonic aciduria combined with hyperhomocysteinemia (MMACHC).Methods The clinical data of 10 children with methylmalonic aciduria combined with hyperhomocysteinemia and who had cardiovascular system involvement were retrospectively analyzed and the treatment outcomes were followed up.Results In the 10 patients, there were 4 cases with initial presentations of cardiovascular system symptoms such as shortness of breath and dyspnea, 3 cases with urinary tract symptoms such as edema, hematuria and proteinuria, and 3 cases with nervous system symptoms such as developmental retardation and convulsions. The 10 patients had different types and severity of cardiovascular injuries. After 3 months to 8 years of follow-up, the congenital heart defects resolved naturally in 2 cases, and the patient with arrhythmia had no obvious changes. In 5 cases of hypertension, blood pressures recovered to normal in 3 cases, and 1 case was lost to follow-up. In 5 patients with pulmonary hypertension, 2 died, 2 recovered, and 1 case had mildly elevated pulmonary artery pressure. Seven patients underwent MMACHC gene testing, and 5 showed c.80A>G mutations.Conclusions Metabolic disease should be taken into account for the children with unexplained pulmonary hypertension and hypertension with the onset of the shortness of breath and dyspnea. The severity of cardiovascular system involvement might be one of the most important factors affecting the prognosis of children with MMACHC. Cardiavascular system involvement of the patients may be related to MMACHC c.80A>G mutations.