15 851例遗传代谢病高危患儿的临床分析

Clinical analysis of 15 851 children at risk of inherited metabolic diseases

摘要:

目的 探讨尿气相色谱-质谱法在遗传代谢病（IMD）高危患儿筛查中的应用价值，以及确诊IMD的疾病谱和确诊IMD患儿的临床特点，为临床诊断和治疗提供参考。方法 回顾性分析2012年2月至2016年12月在天津市儿童医院就诊的15 851例IMD高危患儿且接受了尿气相色谱-质谱法检测的患儿的临床资料。结果 15 851例IMD高危患儿中，检出代谢异常5 793例，占36.55%。确诊为IMD 117例（0.74%），其中甲基丙二酸血症77例（65.8%）。新生儿期IMD确诊患儿的临床表现主要为黄疸、代谢性酸中毒、肌张力异常、喂养困难、反应差、嗜睡或昏迷等，非新生儿期IMD确诊患儿的临床表现主要为精神运动发育落后、代谢性酸中毒、抽搐、反复呕吐、贫血等。结论 气相色谱-质谱法是对IMD高危患儿筛查的有效方法；甲基丙二酸血症是最常见的IMD；新生儿期和非新生儿期IMD确诊患儿的临床表现有不同。

Abstract:

Objective To explore the value of urine gas chromatography-mass spectrometry (GC-MS) in the screening of children at risk of inherited metabolic diseases (IMD), and to identify the disease spectrum of IMD and the clinical characteristics of children with IMD. Methods The clinical data of 15 851 children at risk of IMD who underwent urine GC-MS in the Tianjin Children's Hospital between February 2012 and December 2016 were retrospectively analyzed. Results In the 15 851 children, 5 793 (36.55%) were detected to have metabolic disorders. A total of 117 (0.74%) children were confirmed to have IMD, including 77 cases of methylmalonic acidemia (65.8%). The clinical manifestations of confirmed cases in the neonatal period mainly included jaundice, metabolic acidosis, abnormal muscular tension, feeding difficulty, poor response, and lethargy or coma. The clinical manifestations of confirmed cases in the non-neonatal period mainly included delayed mental and motor development, metabolic acidosis, convulsion, recurrent vomiting, and anemia. Conclusions GC-MS is an effective method for the screening for IMD in children at risk. Methylmalonic acidemia is the most common IMD. The clinical manifestations of IMD are different between the confirmed cases in the neonatal and non-neonatal periods.