山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (10): 103-109.doi: 10.6040/j.issn.1671-7554.0.2021.0985
安袁笑雪1,赵玉英2,赵翠芬3,许瑞英3,薛玉文1
AN Yuanxiaoxue1, ZHAO Yuying2, ZHAO Cuifen3, XU Ruiying3, XUE Yuwen1
摘要: 目的 探讨甲基丙二酸血症(MMA)与肺动脉高压的关系。 方法 回顾分析2例合并型MMA并发肺动脉高压患者的临床特点及基因特征,并复习相关文献,进行总结。 结果 2例患儿均尿甲基丙二酸水平升高及血同型半胱氨酸(Hcy)升高,符合合并型MMA的诊断;均具有肺动脉高压,并伴有持续性的肾脏损伤,其中1例伴有球形红细胞增多症,1例伴有眼球震颤。2例患儿基因检测显示均有MMACHC基因突变. 故为CblC缺陷型,1例基因突变型为:c.80A> G(p.Gln27Arg)/ c.609G> A(p.Trp203Ter)杂合型,1例为c80A>G(p.Gln27Arg)/ c.637G>T(p.Glu213Ter)杂合型,均最终死于肺动脉高压。 结论 儿童及青少年不明原因肺动脉高压应注意遗传代谢疾病的筛查,特别是对MMA的筛查。
中图分类号:
[1] Hansmann G. Pulmonary hypertension in infants, children, and young adults[J]. J Am Coll Cardiol, 2017, 69(20): 2551-2569. [2] Luciani A, Devuyst O. Methylmalonyl acidemia: from mitochondrial metabolism to defective mitophagy and disease[J]. Autophagy, 2020, 16(6): 1159-1161. [3] Kovacs G, Dumitrescu D, Barner A, et al. Definition, clinical classification and initial diagnosis of pulmonary hypertension: updated recommendations from the Cologne Consensus Conference 2018[J]. Int J Cardiol, 2018, 272S: 11-19. doi: 10.1016/j.ijcard.2018.08.083. [4] McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association[J]. J Am Coll Cardiol, 2009, 53(17): 1573-1619. [5] 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组, 等. 中国肺动脉高压诊断与治疗指南(2021版)[J]. 中华医学杂志, 2021, 101(1): 11-51. [6] Wang F, Han L, Yang Y, et al. Clinical, biochemical, and molecular analysis of combined methylmalonic acidemia and hyperhomocysteinemia(cblC type)in China[J]. J Inherit Metab Dis, 2010, 33(Suppl 3): S435-S442. [7] Zhou W, Li H, Wang C, et al. Newborn screening for methylmalonic acidemia in a Chinese population: molecular genetic confirmation and genotype phenotype correlations[J]. Front Genet, 2018, 9: 726. doi: 10.3389/fgene.2018.00726. [8] Han B, Cao Z, Tian L, et al. Clinical presentation, gene analysis and outcomes in young patients with early-treated combined methylmalonic acidemia and homocysteinemia(cblC type)in Shandong Province, China[J]. Brain Dev, 2016, 38(5): 491-497. [9] Baumgartner MR, Hörster F, Dionisi-Vici C, et al. Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia[J]. Orphanet J Rare Dis, 2014, 9: 130. doi: 10.1186/s13023-014-0130-8. [10] Carrillo-Carrasco N, Chandler RJ, Venditti CP. Combined methylmalonic acidemia and homocystinuria, cblC type. I. Clinical presentations, diagnosis and management[J]. J Inherit Metab Dis, 2012, 35(1): 91-102. [11] Watkins D, Rosenblatt DS. Inborn errors of cobalamin absorption and metabolism[J]. Am J Med Genet C Semin Med Genet, 2011, 157C(1): 33-44. [12] Haberle J, Chakrapani A, Ah Mew N, et al. Hyperammonaemia in classic organic acidaemias: a review of the literature and two case histories[J]. Orphanet J Rare Dis, 2018, 13(1): 219. [13] Fraser JL, Venditti CP. Methylmalonic and propionic acidemias: clinical management update[J]. Curr Opin Pediatr, 2016, 28(6): 682-693. [14] Martinelli D, Deodato F, Dionisi-Vici C. Cobalamin C defect: natural history, pathophysiology, and treatment[J]. J Inherit Metab Dis, 2011, 34(1): 127-135. [15] Liu Y, Liu YP, Zhang Y, et al. Heterogeneous phenotypes, genotypes, treatment and prevention of 1 003 patients with methylmalonic acidemia in the mainland of China[J]. Zhonghua Er Ke Za Zhi, 2018, 56(6): 414-420. [16] Profitlich L, Kirmse B, Wasserstein MP, et al. Resolution of cor pulmonale after medical management in a patient with cblC-type methylmalonic aciduria and homocystinuria: a case report[J]. Cases J, 2009, 2: 8603. doi: 10.4076/1757-1626-2-8603. [17] Bouts AH, Roofthooft MTR, Salomons GS, et al. CD46-associated atypical hemolytic uremic syndrome with uncommon course caused by cblC deficiency[J]. Pediatr Nephrol, 2010, 25(12): 2547-2548. [18] Iodice FG, Di Chiara L, Boenzi S, et al. Cobalamin C defect presenting with isolated pulmonary hypertension[J]. Pediatrics, 2013, 132(1): e248-e251. [19] Kömhoff M, Roofthooft MT, Westra D, et al. Combined pulmonary hypertension and renal thrombotic microangiopathy in cobalamin C deficiency.[J]. Pediatrics, 2013, 132(2): e540-e544. [20] Gunduz M, Ekici F, Ozaydin E, et al. Reversible pulmonary arterial hypertension in cobalamin-dependent cobalamin C disease due to a novel mutation in the MMACHC gene[J]. Eur J Pediatr, 2014, 173(12): 1707-1710. [21] Grangé S, Bekri S, Artaud-Macari E, et al. Adult-onset renal thrombotic microangiopathy and pulmonary arterial hypertension in cobalamin C deficiency[J]. The Lancet, 2015, 386(9997): 1011-1012. [22] 齐艳华, 齐建光, 刘玉鹏, 等.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[J].中国当代儿科杂志, 2015, 17(9): 965-970. QI Yanhua, QI Jianguang, LIU Yupeng, et al.Clinical analysis and follow-up study of cardiavascular system involvement in 10 children with methylmalonic aciduria combined with hyperhomocysteinemia[J]. Chinese Journal of Contemporary Pediatrics, 2015, 17(9): 965-970. [23] Kido J, Mitsubuchi H, Sakanashi M, et al. Pulmonary artery hypertension in methylmalonic acidemia[J]. Hemodial Int, 2017, 21(2): E25-E29. [24] 刘雪芹, 闫辉, 邱建星, 等.甲基丙二酸尿症相关肺高血压临床特点与基因突变[J].北京大学学报(医学版), 2017, 49(5): 768-777 LIU Xueqin, YAN Hui, QIU Jianxing, et al. Pulmonary arterial hypertension as leading manifestation of methylmalonic aciduria: clinical characteristics and gene testing in 15 cases[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 768-777. [25] De Simone L, Capirchio L, Roperto RM, et al. Favorable course of previously undiagnosed Methylmalonic Aciduria with Homocystinuria(cblC type)presenting with pulmonary hypertension and aHUS in a young child: a case report[J]. Ital J Pediatr, 2018, 44(1): 90. [26] Petropoulos TE, Ramirez ME, Granton J, et al. Renal thrombotic microangiopathy and pulmonary arterial hypertension in a patient with late-onset cobalamin C deficiency[J]. Clin Kidney J, 2018, 11(3): 310-314. [27] Yoshizawa H, Nogami K, Yaoi H, et al. Pulmonary hypertension with diffuse lung lesions in cobalamin C defect[J]. Pediatr Int, 2019, 61(10): 1062-1063. [28] 林毅, 张冲, 张秋业.以肺动脉高压及慢性肾功能不全为主要表现的合并型甲基丙二酸血症1例[J].中华实用儿科临床杂志, 2019, 34(10): 788-789 LIN Yi, ZHANG Chong, ZHANG Qiuye. Case report of combined methylmalonic acidemia mainly manifested by pulmonary hypertension and chronic kidney failure[J]. Chinese Journal of Applied Clinical Pediatrics, 2019, 34(10): 788-789. [29] 唐晓蕾, 杨海明, 刘辉, 等.以弥漫性肺疾病为突出或首发表现的甲基丙二酸血症合并高同型半胱氨酸血症临床分析[J].中华儿科杂志, 2019, 57(8): 620-624 TANG Xiaolei, YANG Haiming, LIU Hui, et al. Clinical analysis of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation[J]. Chinese Journal of Pediatrics, 2019, 57(8): 620-624. [30] Liao HY, Shi XQ, Li YF. Metabolic and genetic assessments interpret unexplained aggressive pulmonary hypertension induced by methylmalonic acidemia: a case report[J]. World J Clin Cases, 2020, 8(6): 1137-1141. [31] Liu J, Tang X, Zhou C, et al. Cobalamin C deficiency presenting with diffuse alveolar hemorrhage and pulmonary microangiopathy[J]. Pediatr Pulmonol, 2020, 55(6): 1481-1486. [32] Wen LY, Guo YK, Shi XQ. Pulmonary hypertension in late-onset Methylmalonic Aciduria and Homocystinemia: a case report[J]. BMC Pediatr, 2020, 20(1): 243. [33] Zhang YN, Pi YL, Yan X, et al. Methylmalonic acidemia complicated by homocystinuria diseases: a report of three cases[J]. Adv Ther, 2020, 37(1): 630-636. [34] 白薇, 齐建光, 齐艳华, 等.甲基丙二酸尿症并同型半胱氨酸血症患儿心血管系统受累情况、血浆硫化氢水平及基因分析[J].中华实用儿科临床杂志, 2020, 35(9): 681-685 BAI Wei, QI Jianguang, QI Yanhua, et al. Clinical characteristics, plasma levels of hydrogen sulfide and gene analysis of cardiovascular involvement in children with methylmalonic acidemia and homocystinemia[J]. Chinese Journal of Applied Clinical Pediatrics, 2020, 35(9): 681-685. [35] Steed MM, Tyagi SC. Mechanisms of cardiovascular remodeling in hyperhomocysteinemia[J]. Antioxid Redox Signal, 2011, 15(7): 1927-1943. [36] Esse R, Barroso M, Tavares de Almeida I, et al. The contribution of homocysteine metabolism disruption to endothelial dysfunction: state-of-the-art[J]. Int J Mol Sci, 2019, 20(4): 867. [37] Küpeli E, Cengiz C, Cila A, et al. Hyperhomocysteinemia due to pernicious anemia leading to pulmonary thromboembolism in a heterozygous mutation carrier[J]. Clin Appl Thromb Hemost, 2008, 14(3): 365-368. [38] Sun W, Liao JP, Hu Y, et al. Pulmonary embolism and deep vein thrombosis caused by nitrous oxide abuse: a case report[J]. World J Clin Cases, 2019, 7(23): 4057-4062. [39] Low LYH, Sia CH, Tay EL, et al. Chronic thromboembolic pulmonary hypertension and homocysteinaemia[J]. QJM, 2018, 111(2): 121-122. [40] Kim J, Kim H, Roh H, et al. Causes of hyperhomocysteinemia and its pathological significance[J]. Arch Pharm Res, 2018, 41(4): 372-383. [41] Montani D, Lau EM, Dorfmüller P, et al. Pulmonary veno-occlusive disease[J]. Eur Respir J, 2016, 47(5): 1518-1534. [42] Haijes HA, van Hasselt PM, Jans JJM, et al. Pathophysiology of propionic and methylmalonic acidemias. Part 2: Treatment strategies[J]. J Inherit Metab Dis, 2019, 42(5): 745-761. [43] Montani D, Price LC, Dorfmuller P, et al. Pulmonary veno-occlusive disease[J]. Eur Respir J, 2009, 33(1): 189-200. |
[1] | 曾媛媛,杨东鹏,董柱,张本,曹一秋,王晓武. 川芎嗪对野百合碱诱导大鼠肺动脉高压的影响及机制[J]. 山东大学学报 (医学版), 2022, 60(11): 63-69. |
[2] | 王波,薛江,刘爱虹,翟蕊蕊,王一彪. 雷帕霉素调控巨噬细胞表型改善肺动脉高压[J]. 山东大学学报 (医学版), 2018, 56(4): 51-57. |
[3] | 张栾,陈欧,栾云,朱晓波,陈元,王一彪. Gemigliptin对野百合碱诱导的肺动脉高压大鼠治疗作用及炎症因子的影响[J]. 山东大学学报(医学版), 2017, 55(5): 19-22. |
[4] | 许天一,吴萍,王爱玲,陈丽萍. 米力农雾化治疗小儿重症肺炎合并心力衰竭的疗效[J]. 山东大学学报(医学版), 2016, 54(7): 88-90. |
[5] | 潘艳艳,孙永超,赵翠芬,孔清玉. 波生坦治疗婴儿先心病合并肺动脉高压的临床观察[J]. 山东大学学报(医学版), 2016, 54(2): 53-56. |
[6] | 刘慧敏, 刘邓, 李晓宇, 邹淑奉, 姜黎民, 李玉环. 半边莲生物碱对肺动脉高压大鼠ET-1信号通路的影响[J]. 山东大学学报(医学版), 2015, 53(8): 1-4. |
[7] | 唐蒙蒙, 金女娃, 刘传振, 刘凯, 曹广庆, 王鹤, 庞昕焱, 吴树明. 丙酮酸乙酯对高动力性肺高压的治疗作用[J]. 山东大学学报(医学版), 2015, 53(5): 75-80. |
[8] | 王亚云1, 王一彪1, 张雪1, 林梅1, 苏宏1,马宇1,朱晓波1, 陈欧2. PS-341对肺动脉高压大鼠Nrf2/NF-κB表达的影响及作用机制[J]. 山东大学学报(医学版), 2014, 52(2): 6-11. |
[9] | 孟庆红1,赵翠芬1,孔清玉1,李福海1,李栋2,夏伟1. 尾加压素Ⅱ对大鼠肺动脉平滑肌细胞胶原合成的影响[J]. 山东大学学报(医学版), 2013, 51(5): 15-19. |
[10] | 薛明华1, 张琴2, 侯代伦1,徐庆国2,隋树建3. 组织多普勒成像对肺动脉高压患者右心功能的评价[J]. 山东大学学报(医学版), 2013, 51(4): 37-41. |
[11] | 吴文振1, 郝恩魁1,程义伟1,解崔环2,孟彦3,苏国海1. 不同急性肺动脉高压模型的建立及其血流动力学转归的实验研究[J]. 山东大学学报(医学版), 2012, 50(3): 34-39. |
[12] | 林梅1,王一彪1,苏宏1,马宇1,索琳1,陈鸥2,朱晓波3. Smad信号通路及CTGF在依那普利抑制高肺血流性肺动脉高压形成中的作用机制[J]. 山东大学学报(医学版), 2011, 49(9): 16-. |
[13] | 张兆华1,王一彪1,栾云2,苏宏1,马宇1,林梅1,孙若鹏3 . 骨髓间充质干细胞移植治疗实验性大鼠肺动脉高压损伤的作用[J]. 山东大学学报(医学版), 2011, 49(8): 31-. |
[14] | 张凤伟1, 吴树明2, 曹广庆2, 陆现硕2. eNOS基因转染治疗兔肺动脉高压及肺动脉高压危象[J]. 山东大学学报(医学版), 2010, 48(9): 19-24. |
[15] | 王丽娟1,赵翠芬1,常萍1,夏伟1,王荣2,孙若鹏1. ADM和PAMP在高肺血流肺动脉高压形成中的变化及作用途径研究[J]. 山东大学学报(医学版), 2010, 48(2): 28-. |
|