先天性眼外肌纤维化综合征的临床分析

Clinical investigation of the syndrome of congenital fibrosis of extraocular muscles

目的探讨先天性眼外肌纤维化综合征(CFEOM)患病家系及散发病例的临床表现和诊断方法。方法回顾性总结和分析6个CFEOM患病家系和7例散发病例的临床特征,包括遗传学特征、性别、初诊年龄、临床表现、上睑下垂特征、异常神经支配情况。结果6个患病家系均具有常染色体显性遗传特征,均为广泛纤维化综合征,下直肌受累最明显,除1例患者单眼受累外,其他患者均为双眼受累;患病家系中受检患者29例,2例无上睑下垂,7例无异常神经支配症状。在7例散发患者中,男女比例为2∶5,3例为单眼受累;固定性内斜视3例,合并下直肌纤维化的广泛纤维化综合征3例,合并上直肌纤维化的广泛纤维化综合征1例;1例为单眼上睑下垂,4例无眼睑下垂症状;2例合并异常神经支配症状。结论CFEOM患者在临床少见,且临床表现复杂多样,充分重视和掌握临床特征并结合遗传基因分析是临床进行正确诊断的基础。目前的分类方法尚不完善,需对其发病机制进行更为深入的研究。

Objective To analyze the clinical manifestations of congenital fibrosis of the extraocular muscles(CFEOM) both in their pedigrees and sporadic cases.Methods Six families and seven sporadic cases of CFEOM were retrospectively analyzed in the study. The clinical features including genetic characteristics, sex, age of first visit, major complains, subclassifications, features of ptosis and aberrant innervation were evaluated. Results The six families of CFEOM were autosomal dominant inherited traits and classified to the general fibrosis of the extraocular muscles with the inferior rectus muscles affected most severly. All patients except for 1 had binocular involvement. 2 out of the 29 affected members had ptosis and 7 had no aberrant innervation. The male-to-female ratio of the 7 sporadic cases was 2∶5. 3 cases had monocular involvement. Among all the sporadic cases 3 cases were general fibrosis syndrome combined with inferior rectus fibrosis, 1 case was general fibrosis syndrome combined with superior rectus fibrosis, 3 cases were esotropia fixus.1 patient had monocular ptosis while 4 patients had no ptosis.5 patient had no aberrant innervation while the other two had. Conclusions Clinically, the cases of CFEOM are relatively few but the clinical manifestations are complex. The combination of clinical characteristics and genetic analysis are the basis for the establishment of diagnosis. Further research is needed to understand the pathogenesis of the disease.