HBA2基因非编码区罕见突变分子诊断及家系分析

目的:对1例不符合遗传规律的α-地中海贫血病例进行分子诊断及家系分析,探索新发现的罕见突变(HBA2:c.*12G>A)对临床表型的影响。方法:采集先证者及其家系成员的血液样本进行血常规检测,毛细管电泳法进行血红蛋白组分分析,常规技术(Gap-PCR、RDB-PCR)检测中国人群常见的α-及β-珠蛋白基因位点,Sanger测序法分析α-珠蛋白基因序列(HBA1、HBA2)。结果:通过分析先证者及其家系成员的检测结果,检出先证者基因型为-α^(3.7)/HBA2:c.*12G>A,其父亲为罕见α-珠蛋白基因HBA2:c.*12G>A杂合突变携带者。结论:本研究发现了一种未报道的罕见α-珠蛋白基因突变HBA2:c.*12G>A,其杂合突变携带者表现为静止型α-地中海贫血。

保山市育龄人群地中海贫血基因诊断结果分析

目的了解云南省保山市育龄人群地中海贫血基因携带情况。方法利用高通量测序技术对874例样本进行α-地贫及β-地贫检测,统计分析人群分布特征。结果874例样本中检出地贫基因阳性样本251例,地贫基因的人群阳性率为28.72%(251/874);α-地贫基因阳性样本140例,阳性率为16.02%(140/874),以基因突变类型αα/-α^(3.7)为主;β-地贫阳性样本95例,阳性率为10.87%(95/874),以基因型CD26为主;αβ-复合型地贫基因阳性样本16例,阳性率为1.83%(16/874);汉族人群和少数民族人群地贫携带差异性比较差异具有统计学意义(P<0.01)。此外另检出α-珠蛋白基因三联体阳性率为1.49%(13/874),以基因型ααα^(anti3.7)为主。结论保山市是地贫高发地区,地中海贫血阳性率较高,最为常见的突变类型是αα/-α^(3.7)和CD26。研究对保山地区地贫防控、临床遗传咨询工作提供了一定的理论依据。

广州市从化区育龄人群α-珠蛋白生成障碍性贫血筛查及基因鉴定结果分析

目的了解和分析广州市从化区育龄人群中α-珠蛋白生成障碍性贫血发病率及基因突变类型。方法应用血细胞分析和血红蛋白电泳对24083例育龄人群血样进行初筛,初筛阳性者采用跨越断裂点聚合酶链反应(GAP-PCR)和PCR反向点杂交技术检测α-珠蛋白变异基因,使用PCR反向点杂交方法检测β-珠蛋白17种常见突变基因。结果经基因鉴定共检出α-珠蛋白生成障碍性贫血基因异常者2596例,异常发生率10.78%。α-β复合基因突变者170例,复合发生率0.71%。在突变基因中,包括缺失型2550例,占98.23%;非缺失型46例,占1.77%。共含有14种基因突变类型,其中血红蛋白H(HbH)病5种,以--^(SEA)/-α^(3.7)为主;轻型4种,--^(SEA)/αα基因型达到了68.61%;静止型5种,占比最高的前两种基因型为-α^(3.7)/αα和-α^(4.2)/αα。αβ复合基因突变类型检出23种,检出率最高的前六种分别为--^(SEA)/β^(CD41-42),-α^(3.7)/β^(CD41-42),--^(SEA)/β^(654),--^(SEA)/-28,-α^(3.7)/β^(654)和-α^(3.7)/βCD17,占全部复合类型的75.27%。结论广州市从化区α-珠蛋白生成障碍性贫血基因异常发生率较高,基因突变类型和构成比具有自己的特点,是α-珠蛋白生成障碍性贫血一个较为特殊的区域。

红细胞参数和血红蛋白A2在α-地中海贫血筛查中的价值

目的探讨平均红细胞体积(MCV)、平均红细胞血红蛋白(MCH)、平均红细胞血红蛋白浓度(MCHC)和血红蛋白A2(HbA2)在α-地中海贫血(简称α-地贫)筛查中的价值。方法选取2019年1月至2020年12月在桂林医学院第二附属医院进行地中海贫血基因检测,确诊为α-地贫患者223例,以及地中海贫血基因诊断阴性的健康对照者689例为研究对象,分析其血常规检查和血红蛋白电泳检测结果,并运用受试者工作曲线(ROC曲线)评估各指标对α-地中海贫血的筛查性能。结果223例α-地贫患者中,标准型α-地贫最常见,以-SEA/αα基因型为主。各型α-地贫患者的MCV、MCH、MCHC、HbA2值均低于非地贫对照组,差异均具有统计学意义(P<0.01)。MCV、MCH、MCHC、HbA2单独作为α-地贫筛查指标时,ROC曲线下面积分别为0.94、0.96、0.90,0.79灵敏度分别为87.44%、92.83%、83.41%、70.40%,特异度分别为89.55%、90.13%、81.42%、75.76%;HbA2对不同类型α-地贫的筛查效能不同,其中静止型、标准型、中间型α-地贫的ROC曲线下面积分别为0.68、0.87、1.00;结合临床需求,建议本实验室使用MCV<84.45 fL、MCH<28.45 pg、MCHC<330.30 g/L和HbA2<2.85%作为α-地中海贫血的筛查标准。结论MCV、MCH和MCHC对于筛查α-地贫具有较高的灵敏度和特异性,HbA2可作为独立筛查指标用于桂林地区中间型α-地贫的筛查,但对于静止型及标准型α-地贫的筛查可能会造成漏检,必要时可直接进行基因诊断以提高诊断α-地贫的准确度,减少漏检。

Amelioration of β^(654)-thalassemia in mouse model with the knockdown of aberrantly spliced β-globin mRNA

Large amounts of aberrantly spliced mRNA from the β^654 allele was present in erythroid cells, which might impair the erythropoiesis. A therapeutic strategy for β-thalassemia was explored by knocking down the aberrantly spliced mRNA of β-globin. Lentiviral vector with siRNA fragment targets on the specific portion of β^654-globin aberrantly spliced pre-mRNA was constructed. In HeLa β^654 cells, the siRNA vector could reduce approximately 60% of aberrantly spliced mRNA, which was assessed by RT-PCR and qRT-PCR. Furthermore, a disease model of β^654 thalassemia mice with lentiviral-mediated siRNA was produced by subzonal injection （named Hβi-Hbb^th-4/Hbb^＋ transgenic mice）. Our results showed that the hemotological parameters were improved in Hβi-Hbb^th-4/Hbb^＋ transgenic mice. This study provides a potential way for β^654-thalassemia therapy by knocking down the aberrantly spliced β-globin mRNA, whilst supporting that the aberrantly spliced β-globin mRNA may aggravate the disease.

Detection of rare mutation of β-thalassemia by direct sequence analysis of the PCR products

A technique of direct sequence analysis of β-globin gene with the products of amplifi-cation by polymerase chain reaction (PCR) was reported and a case of β-thalassemia with therare mutation in Chinese,‘codon 14/15 (+G)’ was detected by this method.After the se-quence of the mutation site was determined,an analysis of the restriction map of the gene anddot blot hybridization with radioactive allele specific oligonucleotide probe was designed to con-firm the result of DNA sequencing.

Myeloproliferative neoplasms complicated withβ-thalassemia:Two case report

BACKGROUND BCR-ABL-negative myeloproliferative neoplasms(MPNs)are clonal hematopoietic stem cell disorders characterized by the proliferation of one or more myeloid lineages and by mutually exclusive JAK2 V617F,CALR,and MPL[A1]mutations.The combination of MPN and thalassemia is extremely unusual.Several cases with myeloproliferative neoplasms andβ-thalassemia have been reported.However,these have not been extensively reviewed.The present report describes two cases of myeloproliferative neoplasms complicated withβ-thalassemia and reviews all similar cases reported in the literature.CASE SUMMARY We report two patients who were diagnosed with myeloproliferative neoplasms complicated withβ-thalassemia.Both patients had abnormal increases in platelet counts.Based on bone marrow pathology and molecular biology assessment,we made the diagnosis of myeloproliferative neoplasms complicated withβ-thalassemia.The female patient was given hydroxyurea and interferon,which enabled good control of her blood counts;the male patient was given ruxolitinib tablets,thalidomide tablets,and interferon to control the condition,but the patient poorly responded to drug treatment and died of gastrointestinal bleeding six months later.CONCLUSION Given the findings of our cases and the literature review,we hypothesize that myeloproliferative neoplasms complicated withβ-thalassemia can lead to rapid disease progression and a poor prognosis.

A rapid reverse dot blot assay for all 18 β-thalassemia mutations in Chinese population

A set of allele-specific oligonucleotide (ASO) probes used for detecting all 18 β-tha-lassemia mutations found in Chinese was immobilized on two strips of Biodyne C membrane;one containing 7 pairs of oligonucleotide probes specific for the most commonly found mutant al-leles,and the other containing the remaining 11 pairs of ASO_s specific for the less commonlyfound.The membranes were hybridized with β-globin sequences amplified by polymerase chainreaction (PCR) with biotinylated primers,and then treated with Streptavidin-POD conjugateand substrates for color development.The method has been applied successfully to the detectionof all 18 Chinese β-thalassemia mutations and prenatal diagnosis of two high-risk pregnancies ofβ-thalassemia.Patients with homozygous,heterozygous and compound heterozygous alleles ofthese mutations and normal individuals could be easily distinguished by the present method.Us-ing the immobilized-probe format (reverse dot blot),it was able to screen simultaneously multi-ple β-thalassemia mutations of a DNA sample by performing hybridization only once.This assayis simple,rapid and independent of radio-isotopes and can be appplied for all 18 β-thalassemiamutations so far found in Chinese population.It is considered that this method may be usefulfor gene frequency investigation of large numbers of β-thalassemia DNA samples and used as aroutine method in the clinic laboratory.

Therapeutic Drug Monitoring of Chelating Agent Deferoxamine for <i>β</i>-Thalassemia Major Patients

Therapeutic drug monitoring is used to prevent or decrease the risk associated with the toxic effects of medication. This study aims to evaluate the potential advantages of Therapeutic Drug Monitoring (TDM) of subcutaneous Deferoxamine injection and prevention of clinical problems in β-thalassaemia major patients. Patients & Methods: Fifty-four thalassemia patients were allocated into two groups;missing, and not missing deferoxamine dose. TDM of Deferoxamine injection and it clinical outcomes was critically studied under the following subheadings: assessment of the adequacy of Deferoxamine usage, serum peak and trough concentrations of Deferoxamine and ferroxamine with needed pharmacokinetics, cardiac parameters and biomarkers, biochemical and hematological indices, adverse effects/toxicity, urinary assessment of Fe, Zn, selenium, and copper levels, compliance to treatment, dose adjustment in correlation to therapeutic index and life style. Results: Demographic data showed no significant difference. Peak plasma concentrations were 144.83±69 and 43.54±39.16 μg/L, while trough concentrations were 33±26.32 and 31.13±21.58 μg/L of Deferoxamine and ferroxamine, respectively. The elimination rate constant was 0.0237±0.00029 min-1, half-life was 34 min, and distribution volume was 0.93±0.078. Although cardiac parameters showed no significant differences, there were significant differences in CK-MB, and hsCRP levels;troponin I value could not be detected. Biochemical and hematological studies showed significant differences in Ferritin B, urea, SGPT, SGOT, alkaline phosphatase, serum albumin and serum calcium. Assessment of adverse effects/toxicity showed significant differences. The correlation of serum ferritin to therapeutic index, and the life style including Vitamin C and/or E administration were assessed for the compliance to treatment. Conclusion: Therapeutic monitoring of chelation therapy by Deferoxamine in β-thalassemia patients is necessary to ensure effective treatment, compliance, and to avoid adverse side effects and toxicity.

Direct antiglobulin test-negative autoimmune hemolytic anemia in a patient withβ-thalassemia minor during pregnancy:A case report

BACKGROUND Severe refractory anemia during pregnancy can cause serious maternal and fetal complications.If the cause cannot be identified in time and accurately,blind symptomatic support treatment may cause serious economic burden.Thalassemia minor pregnancy is commonly considered uneventful,and the condition of anemia rarely progresses during pregnancy.Autoimmune hemolytic anemia(AIHA)is rare during pregnancy with no exact incidence available.CASE SUMMARY We report the case of a 30-year-oldβ-thalassemia minor multiparous patient experiencing severe refractory anemia throughout pregnancy.We monitored the patient closely,carried out a full differential diagnosis,made a diagnosis of direct antiglobulin test-negative AIHA,and treated her with prednisone and intravenous immunoglobulin.The patient gave birth to a healthy full-term baby.CONCLUSION Coombs-negative AIHA should be suspected in cases of severe hemolytic anemia in pregnant patients with and without other hematological diseases.

Determination of Iron（Ⅱ）, Iron（Ⅲ） and Total Iron in Some β -Thalassemia Patients Using Different Analytical Techniques

There are many well-known analytical methods for determination of iron（Ⅱ） and iron（Ⅲ）. Among these methods： Gravimetric, titrimetric, potentiometric, conductometric and batch and flow-injection spectrophotometric methods. In present study, two batch spectrophotometric, atomic absorption spectrometric and biolabo kit methods have been used for determination of iron（Ⅱ）, iron（Ⅲ） and total iron. The present methods have the advantages of high sensitivity, low cost reagent, low operation cost, simplicity, speed and their applications for determination of iron（Ⅱ） and iron（Ⅲ） in some serum samples of normal human and fl-thalasemia patients in Erbil city. For the first time especially in Erbil city attempts were made to use zero, first and second derivative spectra to identify the serum samples of some β-thallasemia patients from the normal human serum samples due to the appearance and resolution of peaks in both cases.

Ischemia Modified Albumin and C-Reactive Protein in Children with β-Thalassemia Major

Background: Beta-thalassemia is a hereditary haemoglobinopathy caused by defective hemoglobin (Hb) β-globin synthesis, leading to excess α-globin chains that cause hemolysis and impair erythropoiesis. Ischemia modified albumin (IMA) is not a signal protein and not generated in pro-inflammatory state alone but rather an end product of oxidative stress. Objectives: The aim of the study was to evaluate ischemia modified albumin (IMA) and C-reactive protein (CRP) in children with β-thalassemia major and its relation to different iron chelators. Patients and Methods: The study was carried on 40 children diagnosed as beta-thalassemia major recruited from the outpatient clinic and the pediatric department, at Al-Zahraa University Hospital, Faculty of medicine for Girls, Al-Azhar University and EL Minia Insurance Hospital. They were 20 male and 20 female, aged from 4 - 11 years. Another 40 apparently healthy children age and sex matched as control group. CRP and IMA were determined for all participants. Results: There were significant increases in serum CRP, IMA and ferritin levels in patients group compared to control group. There were significant decreases of IMA and CRP levels of thalassemic patients on chelation deferiprone (DFP) compared to deferasirox (DFX) P-value (<0.01) for each. There was a significant positive correlation between serum ferritin and both CRP and IMA levels in thalassemic children (r = 0.40, p < 0.01), (r = 0.44, p < 0.01) respectively. There was a significant positive correlation between IMA and CRP in beta-thalassemic patients (r = 0.31, p = 0.02). Conclusion: IMA, CRP and Serum ferritin were higher in children with β-thalassemia major than controls. Moreover, IMA and CRP levels in thalassemic children on deferiprone (DFP) were significantly lower compared with children on deferasirox (DFX). So it could be considered as useful markers in the follow up assessment of thalassemic patients for early detection of complications.

Co-Inheritance of Beta &Delta-Globin Gene (HbYialousa) Mutations in an Iranian <i>β</i>-Thalassemia Carrier

Introduction: Beta-thalassemia is characterized by absence or reduced synthesis of the β-globin. Carriers of β-thalas- semia, typically have microcytic hypochromic anemia and elevated hemoglobin HbA2 and normal HbF level. On the other hand carriers of severe alpha-thalassemia also have similar CBC parameters to that of β-thalassemia with normal HbA2 level. Co-presence of mutations in the β-globin and delta-globin genes (point mutations or deletions) usually give normal HbA2 and elevated HbF level. We report a β-thal carrier with normal level of HbA2 and increased level of HbF who had a point mutation in CD39 on the beta-globin gene and a point mutation in CD27 on the δ-globin gene named Hb-Yialousa. Materials & Methods: An individual with low hematological indices, normal HbA2 and elevated HbF was referred to our center as routine premarital screening program. Mutations in the β-globin and δ-globin genes were screened using ARMS and sequencing methods. Results: The mutation in β- and δ-globin genes were identified as CD39 and CD27 (HbYialousa) respectively. No point mutation or deletion in α-globin gene was identified. Discussion: We showed that normal HBA2 with elevated HbF level is due to co-inheritance of delta-globin gene mutation with mutation in the β-globin gene. When screening for β-thalassemia, one has to either rule out presence of α-globin gene mutation of mutation in the delta-globin gene.

Impact of Ferritin Load on Gonadal Reserve among Regular Transfused β-Thalassemia

Background: Iron overload in association with persistent anemia is responsible for endocrine dysfunction in β-thalassemia patients, blood transfusion combined with iron-chelation can modify life quality in these children, but they tend to suffer from delayed maturity and endocrine dysfunction. Aim: This study aims to correlate degree of hypogonadism to ferritin load in regular transfused β-thalassemia patients. Methods: It was carried out on 30 β-thalassemia major (TM) patients aged 12 to 18 years, puberty was assessed clinically, blood picture on Cell-Dyne 2700, ferritin level and pattern of FSH, LH, testosterone and estradiol before and after gonadotropin (GnRH) analogue stimulation test, they were determined on ARCHITECT ABBOTT system. Results: Twenty patients had not yet achieved puberty, FSH level was 1.45 ± 1.88 mIU/ml before (GnRH) analogue and 3.78 ± 4.19 mIU/ml after 4 hours of injection. LH level was 1.91 ± 4.79 mIU/ml before (GnRH) test, while after 4 hours it was 6.52 ± 7.50 mIU/ml, 88.24% of males had low serum testosterone level, 84.6% of girls had low serum estradiol level, FSH, LH, estradiol, testosterone before and after GNRH analogue were statistically insignificant, mean ferritin level was 3344.32 ± 1142.142 ng/ml, with insignificant correlation to hormonal pattern before and after GnRH therapy. Conclusion: Iron overload and hypogonadism are the presenting data in this study, insignificant correlation between ferritin level and hormonal reserve pattern, there may be another etiology in pathophysiology of low gonadal reserve such as severe anemia, chronic disease and may be genetic predisposition underlying susceptibility to iron toxicity, which need further investigations.

湖北随州地区孕妇α-地中海贫血产前筛查及基因型分布特点研究

目的:探讨随州地区孕妇产前α-地中海贫血(简称α-地贫)检出情况及基因型分布特点,为该地区地贫防控提供科学依据。方法:选择进行产前检查的5275例孕妇,采用红细胞参数分析联合血红蛋白成分进行初筛,对初筛阳性者进行血红蛋白电泳和基因型检测。结果:5275例孕妇中,初筛α-地贫表型阳性581例,阳性率11.01%。581例α-地贫表型阳性孕妇进行α地贫基因检测,185例携带α-地贫基因,检出率为31.84%。在185例确诊的α-地贫基因携带孕妇中,共检出静止型α-地贫(-α^(3.7)/αα、-α^(4.2)/αα、α——(QS125)α/αα、α^(WS122)α/αα、α^(WS142)α/αα)、轻型(-SEA/αα、-α^(3.7)/-α^(3.7)、-α^(3.7)/-α^(4.2)、-α^(4.2)/-α^(4.2)、-α^(3.7)/α^(QS125)α、-α^(3.7)/α^(WS122)α、-α^(3.7)/α^(WS142)α、-α^(4.2)/α^(WS122)α)和中间型(-SEA/-α^(3.7)、-SEA/-α^(4.2))3种α-地贫基因型,其中以静止型(63.24%)和轻型α-地贫(32.43%)居多。α-地贫组与非α-地贫组孕妇血液学参数比较,α-地贫组血红蛋白(Hb)、红细胞体积(MCV)、血红蛋白浓度(MCH)、血红蛋白A_(2)(HbA_(2))均低于非α-地贫组(均P<0.05)。不同基因型α-地贫孕妇血液学参数比较差异有统计学意义(均P<0.05),组间Hb、MCV、MCH、HbA_(2)比较,静止型>轻型>中间型,差异有统计学意义(均P<0.05)。结论:随州市孕妇α-地贫表型阳性率及基因携带率均较高,基因型多样,应加强该地区孕妇的产前α-地贫筛查,防止重度地贫患儿出生。

羟基脲联合辐射对沉默ATRX后细胞周期及凋亡的影响

目的:探讨羟基脲(HU)联合辐射对沉默α-地中海贫血/精神发育迟滞综合征X染色体相关蛋白(ATRX)后A549细胞周期和凋亡的影响,并阐明其可能的分子机制。方法:建立稳定沉默ATRX的A549细胞模型(shATRX-A549),荧光显微镜下观察细胞感染情况,采用Western blotting法检测沉默ATRX细胞中ATRX蛋白表达量验证细胞模型,以shNC-A549细胞作为阴性对照。实验分为对照组、HU组、辐射组(给予8 Gy X射线辐射)和HU+辐射组(给予HU+8 Gy X射线辐射)。流式细胞术检测各组不同细胞周期细胞百分率和细胞凋亡率,采用RNA测序(RNAseq)检测沉默ATRX后各组细胞中mRNA表达,采用Western blotting法检测各组细胞中细胞分裂周期因子(CDC25B)、细胞周期蛋白(Cyclin)B1和细胞周期蛋白依赖性激酶1(CDK1)蛋白表达量。结果:荧光显微下可见shNC-A549和shATRX-A549细胞表达绿色荧光蛋白(GFP);Western blotting法检测,与shNC-A549细胞比较,shATRX-A549细胞中ATRX蛋白表达量明显减少。流式细胞术检测,与对照组比较,HU组shNC-A549细胞中G_(0)/G_(1)期细胞百分率升高(P<0.05),S期和G_(2)/M期细胞百分率明显降低(P<0.05或P<0.01);辐射组shNC-A549细胞中G_(0)/G_(1)期和S期细胞百分率明显降低(P<0.01),G_(2)/M期细胞百分率明显升高(P<0.01);HU+辐射组shNC-A549细胞中G_(0)/G_(1)期细胞百分率明显降低(P<0.01),S期和G_(2)/M期细胞百分率明显升高(P<0.01);与对照组比较,HU组shATRX-A549细胞中G_(0)/G_(1)期细胞百分率升高(P<0.05),G_(2)/M期细胞百分率明显降低(P<0.01);辐射组shATRX-A549细胞中G_(2)/M期细胞百分率明显升高(P<0.01),G_(0)/G_(1)期和S期细胞百分率明显降低(P<0.01);HU+辐射组shATRX-A549细胞中G_(0)/G_(1)期细胞百分率明显降低(P<0.01),S期和G_(2)/M期细胞百分率明显升高(P<0.01);与shNC-A549细胞比较,辐射组shATRX-A549细胞中G_(0)/G_(1)期细胞百分率升高(P<0.05),G_(2)/M期细胞百分率降低(P<0.05);HU+辐射组shNC-A549细胞中S期细胞百分率升高(P<0.05)。与对照组比较,HU组、辐射组和HU+辐射组shNC-A549细胞和shATRX-A549细胞凋亡率明显升高(P<0.05或P<0.01)。与shNC-A549细胞比较,HU组和HU+辐射组shATRX-A549细胞凋亡率升高(P<0.05)。沉默ATRX后mRNA差异表达涉及c-Myc、Esp1、Cdc20、Plk1、CycA/B、Cip1和PCNA。Western blotting法检测,与对照组比较,HU组、辐射组和HU+辐射组shNC-A549和shATRX-A549细胞中CDC25B、Cyclin B1和CDK1蛋白表达量减少;与shNC-A549细胞比较,对照组和HU组shATRXA549细胞中Cyclin B1蛋白表达量略有减少,辐射组和HU+辐射组细胞中CDC25B、Cyclin B和CDK1蛋白表达量均增加。结论:HU和辐射均可导致沉默ATRX的A549细胞周期阻滞和细胞凋亡,其机制与CDC25B/Cyclin B/CDK1通路有关。

韶关市孕产妇α地中海贫血基因检测结果及血液学特征分析

目的探究韶关市孕产妇α地中海贫血基因检测结果及其血液学特征,为产前地中海贫血筛查以及基因诊断提供参考。方法选择2019年10月至2021年10月在韶关市第一人民医院就诊的2200例孕产妇进行研究。所有孕妇均进行地中海贫血产前筛查,初筛阳性患者采用PCR-反向斑点杂交(PCR-RDB)以及单管四重GaP-PCR技术检测α基因类型。采用受试者工作特征曲线(ROC)分析血液学指标[平均红细胞体积(MCV)、平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)、血红蛋白A2(HBA2)]对α地中海贫血的诊断价值。结果2200例孕产妇经血液学和血红蛋白电泳筛查显示,初筛阳性为408例,阳性率为18.5%;经地中海贫血基因检测确诊188例,检出率为8.5%,其中单纯α地中海贫血基因缺失95例,占50.5%;188例确诊地中海贫血孕产妇基因检测共计检出5种α地中海贫血基因缺失类型,其中95例α地中海贫血基因缺失类型中东南亚型缺失(--^(SEA))76例(80.0%),占比最高;地中海贫血基因检测结果阳性孕产妇的MCV、MCH及MCHC水平明显低于检测结果阴性孕产妇,而HBA2水平则明显高于检测结果阴性孕产妇,差异均有统计学意义(P<0.05);对α地中海贫血基因缺失孕产妇血液学指标进行多项分析后建立ROC诊断模型显示,MCV诊断灵敏度为0.873、特异度为0.718,MCH诊断灵敏度为0.897、特异度为0.743,MCHC诊断灵敏度为0.808、特异度为0.759,HBA2诊断灵敏度为0.512、特异度为0.676。结论韶关市α地中海贫血最常见基因缺失类型为东南亚型缺失(--^(SEA)),血液学特征检测对于地中海贫血筛查具有较高临床价值。

成人胶质母细胞瘤TERT启动子和ATRX突变预后价值

目的探究成人胶质母细胞瘤(glioblastoma,GBM)中端粒酶逆转录酶(telomerase reverse transcriptase,TERT)启动子,α-地中海贫血伴智力低下综合征基因(alpha-thalassemia/mental retardation syndrome X-linked,ATRX)突变对预后的影响。方法收集2020年至2022年在徐州医科大学附属医院神经外科行手术治疗的82例GBM患者病理及随访资料。TERT启动子区(C228T和C250T)及ATRX突变检测采用多重PCR扩增+二代测序(next generation sequencing,NGS)方法,根据患者HE染色切片的镜下结果将其分为低级别组织形态的GBM和高级别组织形态GBM两组,分析两组GBM患者TERT启动子和ATRX突变率的差异。GBM患者预后的影响因素采用多因素COX回归分析。结果两组GBM患者中TERT启动子突变率(25.0%vs.75.8%,χ^(2)=12.584,P<0.01)存在统计学差异。年龄≤60岁、术中肿瘤全切、术后放疗、化疗、TERT启动子非突变是影响GBM患者预后的独立保护性因素(P<0.05)。结论TERT启动子突变的GBM患者预后较差、临床中常规检测TERT启动子并结合其他分子标记物有助于正确评估GBM患者预后,有较高临床价值。

广州地区8129对育龄夫妇珠蛋白生成障碍性贫血初筛阳性标本检测结果分析

目的了解广州地区育龄人群中珠蛋白生成障碍性贫血(下称地贫)α、β基因携带率、基因突变类型及其分布情况,为更准确地进行地贫的防控工作提供数据支持,降低出生缺陷。方法收集广州市各区参加免费孕前优生健康检查的夫妇血常规初筛阳性标本,进行毛细管电泳复筛,结合筛查结果,检测常见4种缺失型α-地贫基因、3种突变型α-地贫基因、21种β-地贫基因,对检测结果进行统计分析。结果共收集地贫筛查阳性标本16258例(8129对夫妇),其中,地贫基因携带者6929例,检出α地贫基因携带者5167例(74.57%),β地贫基因携带者2064例(29.79%),α地贫复合β地贫基因携带者312例(4.5%),α地贫基因高风险夫妇184对,双方高风险携带--SEA/αα125对(67.93%),β地贫基因高风险夫妇29对,双方高风险携带β0/βN6对(20.69%)。结论广州地区地贫基因检出率很高,主要以α-地贫为主,对育龄夫妇进行地贫筛查并结合基因检测,将有助于提高出生人口素质。

血红蛋白H病复合非缺失型遗传性胎儿血红蛋白持续存在综合征44例临床分析

目的:探讨复合非缺失型遗传性胎儿血红蛋白持续存在综合征(nd-HPFH)对血红蛋白H病(Hb H病)的影响。方法:收集2022年1—12月在广西医科大学第一附属医院进行地中海贫血筛查诊断为Hb H病的患者148例,对研究对象进行血常规检查,采用高效液相色谱法进行血红蛋白(Hb)分析;DNA测序方法检测γ-珠蛋白基因突变;荧光PCR熔解曲线法和Gap-PCR法检测α-和β-地中海贫血基因突变。结果:148例Hb H病患者中,检出44例复合nd-HPFH,检出率为29.7%,基因突变类型为^(G)γ-158C>T突变杂合子27例,^(A)γ-225~-222缺失杂合子13例,^(G)γ-158C>T突变纯合子2例,^(G)γ-158C>T突变杂合子复合^(A)γ-225~-222缺失纯合子1例,^(G)γ-158C>T突变杂合子复合^(A)γ-225~-222缺失杂合子1例。Hb分析结果显示,1例胎儿血红蛋白(Hb F)升高,为5.3%;血常规检查结果:轻度贫血19例,中度贫血24例,重度贫血1例。地中海贫血基因检测结果:--^(SEA)/α^(CS)α20例、--^(SEA)/-α^(3.7)13例、--^(SEA)/-α^(4.2)9例、--^(SEA)/α^(QS)α1例和--THAI/-α^(3.7)1例。结论:nd-HPFH基因突变在Hb H病患者中有较高的检出率,nd-HPFH复合Hb H病临床贫血表现存在差异;此类患者大多数Hb F正常,临床上容易漏诊。