棒状结构区基因缺失Becker型肌营养不良症的临床特征

Clinical features of patients with Becker muscular dystrophy and deletions of the rod domain of dystrophin gene

目的探讨基因缺失发生于抗肌萎缩蛋白棒状结构区的Becket型肌营养不良症（Becker muscular dystrophy，BMD）的临床特征。方法分析12例基因缺失发生于棒状结构区缺失热点的BMD患者的临床特征、生化检查及心脏功能评估。结果大多数患者以双下肢无力为主诉，2例患者因双小腿痛、1例患者因显著增高的肌酸激酶（creatine kinase，CK）值就诊，还有1例以“发现心脏大”为主诉；所有患者CK值均有不同程度的升高，高峰值位于15~20岁的患者；7例患者（7／8）心电图提示左室高电位、异常Q波、窦性心动过速等异常；7例患者（7／9）的超声心动图结果提示就诊时已有房室增大的特点。结论与DMD相比，BMD临床表现差异较大，基因突变发生于棒状结构区域时尤为显著。肌无力不是BMD患者就诊的唯一主诉。CK中等程度升高不能排除BMD的诊断。对于扩张性心肌病男性患者，应考虑BMD的可能性。

Objective To explore the clinical features of patients carrying deletions of the rod domain of the dystrophin gene. Methods Clinical data of 12 Chinese patients with Becket muscular dystrophy （BMD） and such deletions was reviewed. Results Most patients complained of muscle weakness of lower limbs. Two patients had muscle cramps, one had increased creatine kinase （CK） level, and one had dilated cardiomyopathy. Conclusion Compared with DMD, the clinical features of BMD are much more variable, particularly for those carrying deletions of the rod domain of the dystrophin gene. Muscular weakness may not be the sole complaint of BMD. The diagnosis of BMD cannot be excluded by moderatdy elevated CK. For male patients with dilated cardiomyopathy, the possibility of BMD should be considered.