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山东大学学报(医学版) ›› 2010, Vol. 48 ›› Issue (9): 120-123.

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X连锁无丙种球蛋白血症9例报告并文献复习

孙立锋1,鞠云飞2,蒋利萍3,冯益真1,王金荣1   

  1. 1.山东大学附属省立医院儿科, 济南 250021; 2.山东省胸科医院呼吸一科, 济南 250013;
    3.重庆医科大学附属儿童医院免疫室, 重庆  400014
  • 收稿日期:2010-04-19 出版日期:2010-09-16 发布日期:2010-09-16
  • 作者简介:孙立锋(1976- ),男,主治医师,主要从事小儿呼吸免疫学方面的研究。 E-mail:lifengsun2008@163.com

Review of nine cases of Xlinked agammaglobulinemia

SUN Li-feng1, JU Yun-fei2, JIANG Li-ping3, WANG Jin-rong1, FENG Yi-zhen1   

  1. 1. Department of Padiatrics, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China;
    2. 1st Department of Respiratory Diseases, Chest Hospital of Shandong Province, Jinan 250013,  China;
    3. Department of Immunology, Children′s Hospital of Chongqing Medical University, Chongqing  400014, China
  • Received:2010-04-19 Online:2010-09-16 Published:2010-09-16

摘要:

目的    探讨X连锁无丙种球蛋白血症(XLA)的临床表现、实验室检查特点、治疗及预后。方法    本文对2005年11月至2009年8月在我院确诊的9例XLA患儿的外周血免疫球蛋白及细胞表面分子进行检测,并结合临床症状及体征进行分析,对2例患儿进行Bruton 酪氨酸激酶(BTK)基因测序分析。结果    本组9例患儿均有反复上呼吸道感染和肺炎,其中迁延难愈的中耳炎(3/9)及化脓性关节炎(4/9)多见,皮肤感染(1/9)、双下肢瘫痪(1/9)、扩张性心肌病(1/9)、慢性腹泻(1/9)、多关节炎(1/9)可见。诊断时除1例有明显的生长发育落后外,其余患儿发育正常。外周淋巴结及扁桃体较小或难以查到。实验室检查外周血免疫球蛋白<1.5 g/L和循环B细胞数<1%。其中2例患儿及母系亲属经BTK基因分析证实存在突变。结论    XLA可防可治,规范治疗,预后较好。

关键词: 无丙种球蛋白血症;反复感染;X染色体

Abstract:

Objective    To explore clinical features, therapeutics and prognosis of X-linked agammaglobulinemia(XLA). Methods    9 confirmed XLA patients were analyzed by detecting the peripheral level of immunoglobulin and molecules on the cells′ surface. Clinical features were reviewed. BTK (Bruton′s tyrosine kinase ) gene  sequencing were performed in 2 cases. Results    Recurrent upper respiratory infections and pneumonia were found in all patients. Refractory otitis(3/9) and  purulent arthritis (4/9) were common. Skin infection(1/9), paralysis of legs(1/9), dilated cardiomyopathy(1/9), chronic diarrhea(1/9) and polyarthritis(1/9) appeared in different cases. All but one cases showed normal growth and development. The prominent signs at diagnosis were markedly decreased or absent tonsils and lymph nodes. Concentration of  serum immunoglobulins (Igs) and numbers of peripheral B cells in all cases were dramatically decreased. Two cases demonstrated mutations  of the BTK genes. Conclusion    XLA is preventable and curable. Standard treatment can yield good prognosis.

Key words: Agammaglobulinemia; Recurrent infection; X-chromosome

中图分类号: 

  • R725.9
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