Clinical evolution of antisynthetase syndrome-associated interstitial lung disease after COVID-19 in a man with Klinefelter syndrome:A case report

BACKGROUND This study presents a case of rapidly developing respiratory failure due to antisynthetase syndrome(AS)following coronavirus disease 2019(COVID-19)in a 33-year-old man diagnosed with Klinefelter syndrome(KS).CASE SUMMARY A 33-year-old man with a diagnosis of KS was admitted to the Department of Pulmonary and Critical Care Medicine of a tertiary hospital in China for fever and shortness of breath 2 wk after the onset of COVID-19.Computed tomography of both lungs revealed diffuse multiple patchy heightened shadows in both lungs,accompanied by signs of partial bronchial inflation.Metagenomic next-generation sequencing of the bronchoalveolar lavage fluid suggested absence of pathogen.A biopsy specimen revealed organizing pneumonia with alveolar septal thickening.Additionally,extensive auto-antibody tests showed strong positivity for anti-SSA,anti-SSB,anti-Jo-1,and anti-Ro-52.Following multidisciplinary discussions,the patient received a final diagnosis of AS,leading to rapidly progressing respiratory failure.CONCLUSION This study underscores the clinical progression of AS-associated interstitial lung disease subsequent to viral infections such as COVID-19 in patients diagnosed with KS.

Routine screening for classical azoospermia factor deletions of the Y chromosome in azoospermic patients with Klinefelter syndrome

Aim： To evaluate the occurrence of classical azoospermia factor （AZF） deletions of the Y chromosome as a routine examination in azoospermic subjects with Klinefelter syndrome （KS）. Methods： Blood samples were collected from 95 azoospermic subjects with KS （91 subjects had a 47,XXY karyotype and four subjects had a mosaic 47,XXY/46, XY karyotype） and a control group of 93 fertile men. The values of testosterone, follicle stimulating hormone （FSH） and luteinizing hormone （LH） were measured. To determine the presence of Y chromosome microdeletions, polymerase chain reaction （PCR） of five sequence-tagged site primers （sY84, sY 129, sY 134, sY254, sY255） spanning the AZF region, was performed on isolated genomic DNA. Results： Y chromosome microdeletions were not found in any of the 95 azoosperrnic subjects with KS. In addition, using similar conditions of PCR, no microdeletions were observed in the 93 fertile men evaluated. The level of FSH in KS subjects was higher than that in fertile men （38.2 ± 10.3 mIU/mL vs. 5.4 ±2.9 mIU/mL, P 〈 0.001） and the testosterone level was lower than that in the control group （1.7 ±0.3 ng/mL vs. 4.3 ± 1.3 ng/mL, P 〈 0.001）. Conclusion： Our data and review of the published literature suggest that classical AZF deletions might not play a role in predisposing genetic background for the phenotype of azoospermic KS subjects with a 47,XXY karyotype. In addition, routine screening for the classical AZF deletions might not be required for these subjects. Further studies including partial AZFc deletions （e.g. gr/gr or b2/b3） are necessary to establish other mechanism underlying severe spermatogenesis impairment in KS.

Y chromosome microdeletions in azoospermic patients with Klinefelter's syndrome

Aim： To study the occurrence of Y chromosome microdeletions in azoospermic patients with Klinefelter＇s syndrome （KFS）. Methods： Blood and semen samples were collected from azoospermic patients with KFS （n = 14） and a control group of men of proven fertility （n = 13）. Semen analysis was done according to World Health Organization （WHO） guidelines. Blood samples were processed for karyotyping, fluorescent in situ hybridization （FISH） and measurement of plasma follicle stimulating hormone （FSH） by radioimmunoassay. To determine Y chromosome microdeletions, polymerase chain reaction （PCR） of 16 sequence tagged sites （STS） and three genes （DFFRY, XKRY and RBM1 Y） was performed on isolated genomic DNA. Testicular fine needle aspiration cytology （FNAC） was done in selected cases. Results： Y chromosome microdeletions spanning the azoospermia factor （AZF）a and AZFb loci were found in four of the 14 azoospermic patients with KFS. Karyotype and FISH analysis revealed that, of the four cases showing Y chromosome microdeletion, three cases had a 47,XXY/46,XY chromosomal pattern and one case had a 46,XY/47,XXY/48,XXXY/48,XXYY chromosomal pattern. The testicular FNAC of one sample with Y chromosome microdeletion revealed Sertoli cell-only type of morphology. However, no Y chromosome microdeletions were observed in any of the 13 fertile men. All patients with KFS had elevated plasma FSH levels. Conclusion： Patients with KFS may harbor Y chromosome microdeletions and screening for these should be a part of their diagnostic work-up, particularly in those considering assisted reproductive techniques. （Asian JAndrol 2006 Jan; 8： 81-88）

The role of hypogonadism in Klinefelter Syndrome

Klinefelter syndrome （KS） （47, XXY） is the most abundant sex-chromosome disorder, and is a common cause of infertility and hypogonadism in men. Most men with KS go through life without knowing the diagnosis, as only 25% are diagnosed and only a few of these before puberty. Apart from hypogonadism and azoospermia, most men with KS suffer from some degree of learning disability and may have various kinds of psychiatric problems. The effects of long-term hypogonadism may be difficult to discern from the gene dose effect of the extra X-chromosome. Whatever the cause, alterations in body composition, with more fat and less muscle mass and diminished bone mineral mass, as well as increased risk of metabolic consequences, such as type 2 diabetes and the metabolic syndrome are all common in KS. These findings should be a concern as they are not simply laboratory findings; epidemiological studies in KS populations show an increased risk of beth hospitalization and death from various diseases. Testosterone treatment should be offered to KS patients from early puberty, to secure a proper masculine development, nonetheless the evidence is weak or nonexisting, since no randomized controlled trials have ever been published. Here, we will review the current knowledge of hypogonadism in KS and the rationale for testosterone treatment and try to give our best recommendations for surveillance of this rather common, but often ignored, syndrome.

Novel methylation specific real-time PCR test for the diagnosis of Klinefelter syndrome

The aim of this study was to design a molecular assay for the diagnosis of Klinefelter syndrome （KS）, based on the detection of supernumerary X-chromosomes （X-chs）. DNA was extracted from peripheral blood samples of twenty-six 47,XXY males; two 46,XY/47,XXY males; twenty-two 46,XY males; and 15 females; and deaminated. Methylation-specific quantitative polymerase chain reaction （MS-qPCR） was performed using primers for unmethylated and methylated copies of the X-ch inactive-specific transcript （XIST-U and XIST-M） gene. X-ch disomy was determined on the basis of XIST methylation status. Degree of mosaicism in the 46,XY/47,XXY males was compared with karyotype and fluorescent in situ hybridization （FISH） results. Data analysis was performed using the Roche LightCycler software V. 3.5.3, including determination of crossing points （CPs） by fit-point analysis and melting curve analysis. Xoch disomy was detected in all female controls and KS patients; male controls expressed XIST-M only. CPs ranged from 29.5 to 32.5 （standard deviation （s.d.） 0.8） for XIST-U and from 29 to 31 （s.d. 0.6） for XIST-M. Limit of detection of mosaicism was 1%. Based on XlST-U/XIST-M ratios for the two 47,XXY/46,XY patients, the calculated degree of mosaicism （1.8% and 17.8%） was comparable to FISH results （2.3% and 15%, respectively）. Turnaround time from DNA deamination to final data analysis was under 9 h. We conclude that MS-qPCR is a sensitive, specific and rapid test for the detection of X-ch disomy, with applicability for the screening and diagnosis of KS, even in the setting of low grade 47,XXY/46,XY mosaicism.

Klinefelter综合征青壮年患者反复肋骨脆性骨折一例报告

Klinefelter综合征(Klinefelter syndrome,KS)是最常见的原发性睾丸功能减退症,也是继发性骨质疏松症的原因之一。本文报告一例临床表现为骨痛及反复肋骨脆性骨折的青壮年KS患者,结合文献复习总结经验以提高临床上对KS不典型临床表现的认识,尤其对于非负重骨脆性骨折的病例,临床诊疗思路中,除了需要排除常见的病理性骨折病因以外,还需要注意不常见的病因。

Immunoadsorption therapy for Klinefelter syndrome with antiphospholipid syndrome in a patient:A case report

BACKGROUND Klinefelter syndrome(KS) is a genetic disease of male sex chromosome malformations that affects sperm production and reduces testosterone production. It has been reported that there is currently more than 10 cases of KS combined with antiphospholipid syndrome(APS).CASE SUMMARY Here, we describe a 31-year-old male patient with chromosome 47, XXY type, who suffered deep vein thrombosis of the lower limbs accompanied by abnormal antiphospholipid antibody, lupus anticoagulant and factor VⅢ. After treatment with immunoadsorption therapy, glucocorticoids, cyclophosphamide, intravenous immunoglobulin and anticoagulant therapy, the patient showed dramatic symptomatic improvement. During the follow-up, the patient did not develop any new thrombotic events.CONCLUSION Immunoadsorption combined with glucocorticoid and cyclophosphamide shock comprehensive treatment has achieved significant results for patients with KS combined with antiphospholipid syndrome.

Study on the extra X chromosome＇s effect on the hormone level of Klinefelter＇s syndrome

Klinefelter＇s syndrome is an inherited （genetic） disorder found only in men caused by at least one extra X chromosome in a cell. Does the extra X chromosome have any effect on the hormone level of Klinefelter＇s Syndrome？ In this paper, 25 subjects with Klinefelter＇s syndrome, 30 infertile subjects and 36 normal men without Klinefelter＇s syndrome were compared each other in endocrinology profile and cytogenetics. Subjects with Klinefelter＇s syndrome were identified by the karyotypes 47, XXY or 47, XXY/46XY, and positive of the X-chromatins （Barr bodies）. Hormone analysis of subjects with Klinefelter＇s syndrome showed that the testosterone （T） values were lower than those of the normal subjects, while the FSH and LH values were higher than those of the normal people; in the infertile experiment subjects without Klinefelter＇s Syndrome, the karyotypes are 46, XY, with negative of the X-chromatins. The testosterone （T） values of these subjects were also lower than those of the normal people, but the FSH and LH values were within the normal range. These results indicated that endocrinological test on infertile subjects can be used to determine whether a cytogenetic analysis is necessary, and hence exclude non- Klinefelter＇s syndrome. The mechanism of the occurrence of this difference, its clinical applications and the relationship among the karyotypes, the endocrinological test and the severity of the phenotype are discussed. Lyon＇s hypothesis stating that only one of the two X-chromosomes is genetically active in female cells, but our study concluded that the extra X chromosome do have effect on the hormone level of Klinefelter＇s Syndrome.

Birth after intracytoplasmic sperm injection of ejaculated spermatozoa from a man with mosaic Klinefelter's syndrome

Aim:To report a birth after intracytoplasmic sperm injection (ICSI) of ejaculated spermatozoa from a man with mosaic Klinefelter's syndrome detected by fluorescence in situ hybridization (FISH) analysis.Methods:A 35-year- old man with a normal appearance consulted our hospital because of sterility over a 5-year period.Chromosome analysis showed low-incidence mosaic Klinefelter's syndrome.Using FISH,96 % hyperploidy of the lymphocytes was found.We examined the sex chromosome of the ejaculated spermatozoa.Using FISH,we examined 200 ejacu- lated spermatozoa and no hyperploidy was found.Results:The 33-year-old female partner of the male patient underwent an uncomplicated controlled ovarian hyperstimulation sequence using a combined recombinant-follicle stimulating hormone (rec-FSH) + human menopausal gonadotrophin (hMG) protocol,following late luteal phase pituitary down regulation.This culminated in the retrieval of seven oocytes,six of which were fertilized with ICSI. One ICSI attempt led to clinical pregnancy with a healthy baby girl.Conclusion:We report a male patient with low- incidence mosaic Klinefelter's syndrome whose ejaculated spermatozoa were identified as being haploid by FISH before ICSI,leading to the successful pregnancy of his wife and the birth of a healthy baby girl.

1例嵌合型Klinefelter综合征患者细胞与分子遗传学研究

目的:观察嵌合型Klinefelter综合征的外周血染色体、Y染色体上SRY基因和AZF基因微缺失发生情况。方法:对1例嵌合型Klinefelter综合征患者及父母进行外周血染色体核型分析,确定9个实验用序列标签位点(STS),分别是:sY84、sY86、sY127、sY129、sY134、sY254、sY255、sY242、sY152,同时检测SRY基因,并以X/Y连锁锌指蛋白基因(ZFX/ZFY)为内对照进行多重PCR筛查AZF微缺失。结果:患者核型为46,XY/47,XXY/48,XXYY/49,XXXXY,其中48,XXYY占56%;47,XXY占30%;46,XY占12%;49,XXXXY占2%,患者父母核型正常;患者及父母SRY基因检测与染色体性别一致,患者检出Y染色体AZF微缺失,缺失位点为sY86和sY127,缺失类型为AZFa+AZFb缺失。结论:Klinefelter综合征患者存在Y染色体AZF微缺失,染色体核型分析和Y染色体AZF微缺失是Klinefelter综合征患者重要的遗传检测指标。

Klinefelter综合征合并糖尿病及下肢溃疡一例报道

不孕不育是影响人类生殖健康的重要因素,在男性不育症中染色体异常占2%～8%,其中最为常见的染色体异常疾病是Klinefelter综合征.Klinefelter综合征患者血糖异常的风险明显增加,而且静脉曲张性溃疡的患病率亦增高.本文报道了我科收治的1例Klinefelter综合征合并糖尿病及下肢溃疡的患者,就其临床特点进行分析.

湛江地区85例Klinefelter综合征染色体分析

对湛江地区 85例Klinefelter综合征进行了染色体分析 ,典型Klinefelter综合征占 78% ;嵌合型占 14% ;伴有其它染色体异常者占 4% ;超X型占 4%。讨论了本地区Klinefelter综合征的细胞遗传学病因及其各种类型染色体异常核型与表型的关系。

Klinefelter综合征患者Ag-NOR及Ag-AA的分析

本文对26例Klinefelter综合征患者(16例47,xxy;10例46,xy/47,xxy)作了银染核仁形成区(Ag-NOR)及银染近端着丝粒染色体联合(Ag-AA)频率的研究,探讨X染色体数目增加与基因转录活性及不育之间的关系。结果发现无论是Ag-NOR或Ag-AA的频率均随X染色体增加而递增,47,xxy;46,xy/47,xxy组均与正常对照组差异极显著(P<0.001),而47,xxy组与46,xy/47,xxy组差异显著(P<0.05)

FISH检测精子非整倍体率在Klinefelter综合征辅助生育治疗的应用首例分娩报告

目的 分析Klinefelter综合征病人精子X ,Y ,18染色体的非整倍体率 (aneuploid) ,指导其辅助生育治疗。方法 应用荧光原位杂交 (FISH)检测 1例射出的少量精子X ,Y和 18号染色体 ,计算精子染色体非整倍体率 ,用卵胞浆内单精子注射 (ICSI)治疗。结果 ICSI前后拾取形态正常的精子 ,进行FISH后有荧光信号的精子数为 15 6条 ,其中正常 18/X精子有82条 (5 2 6 % ) ,18/Y精子有 74条 (4 7 4 % ) ,未发现异常的精子信号。ICSI治疗后获得双胎妊娠 ,孕 19w产前诊断 ,2个胎儿的染色体核型分别是 4 6 ,XY和 4 6 ,XX。孕 36w分娩 1男婴和 1女婴。结论 ISH分析证实Klinefelter综合征病人可以产生正常精子 。

Klinefelter综合征患者和双亲对诱变剂敏感性研究

为了解诱变剂对Ｋｌｉｎｅｆｅｌｔｅｒ综合征发生的影响，对Ｋｌｉｎｅｆｅｌｔｅｒ综合征患者、患者双亲及对照进行丝裂霉素Ｃ、乙醛或乙醇诱导非二倍体、染色体结构畸变及微核观察，发现丝裂霉素Ｃ诱导的患者染色体结构畸变和微核均显著多于对照和双亲。乙醛和乙醇能诱导非二倍体和微核增加，但患者和双亲增加的程度极显著高于对照。提示Ｋｌｉｎｅｆｅｌｔｅｒ综合征患者对于丝裂霉素Ｃ、乙醛和乙醇诱导染色体畸变更敏感。双亲对乙醛和乙醇诱变敏感性高则表明易感人群饮酒可导致本病发生。

非嵌合型Klinefelter综合征患者显微取精术研究进展

Klinefelter综合征(KS)是男性最常见的性染色体异常疾病,第二性征发育迟滞或不发育及不育是其最常见临床表现。随着现代辅助生殖技术的发展,KS患者拥有自己遗传学意义后代成为可能。显微睾丸取精术(m TESE)是公认的最佳取精术式,本文就其预测指标、取精成功率、手术方法、术后并发症、术前性激素替代治疗及术后睾酮下降等问题进行综述。

Klinefelter综合征伴糖尿病4例及相关文献复习

目的回顾性分析本院自2016年以来收治的4例Klinefelter综合征(KS)伴糖尿病患者的临床资料,以期提高对本病的认识。方法根据住院及门诊就诊记录,汇总4例KS合并糖尿病患者的病史资料及实验室检查结果并分析。结果4例患者年龄(43.0±12.7)岁,KS确诊年龄(41.5±13.9)岁,身高(1.67±0.07)m,体质指数(BMI)为(22.05±1.87)kg/m2,经治疗后患者血糖及性激素水平明显好转(P<0.05),血脂紊乱无改善(P>0.05)。结论临床上KS早期诊断率低,已婚的成年男性不育是诊断KS的重要线索。KS合并糖尿病除控制血糖及雄激素替代治疗外,应积极处理血脂紊乱、脂肪肝等危险因素。

Klinefelter综合征的早期诊断(附14例报告)

本文总结了14例克氏综合征，最小2岁，最大38岁，表现型为男性，但阴茎短小，睾丸小，性成熟期不能产生精子，细胞核型以47，XXY为最多，占80％，嵌合型占10％，罕见核型占10％。产生机制是经细胞分裂过程中发生性染色体不分离所致，其原因有待进一步探索。口腔粘膜X染色质检查对早期诊断克氏综合征具有重要意义，强调对男性新生儿本病普查的必要性。

Klinefelter综合征患者睾酮水平与内皮祖细胞的相关性分析

目的:分析Klinefelter综合征患者的睾酮水平与循环内皮祖细胞间的相关性及其临床意义。方法:选取在本院就诊的36例非嵌合体核型47,XXY的患者,且患者均伴有一个或多个心血管危险因素。放免法检测相关激素水平,并测定循环内皮祖细胞含量;予以睾酮替代疗法6个月后,复查激素水平及循环内皮祖细胞含量。结果:予以睾酮替代治疗后,患者睾酮水平由(8±3)nmol/L升高至(24±10)nmol/L,循环内皮祖细胞含量为(41±48)cells/ml,未见明显升高。结论:Klinefelter综合征患者睾酮水平与循环内皮祖细胞含量无明显相关性。

Klinefelter综合征1例并文献复习

目的探讨Klinefelter综合征的临床特点。方法回顾性分析兰州大学第二医院收治的1例Klinefelter综合征患者的病例资料,并复习相关文献。结果患者为青年男性,双侧乳房增大伴疼痛3年。入院后查体发现男性第二性征发育不全,睾丸硬小,卵泡刺激素、黄体生成素水平显著升高,睾酮水平明显下降,行相关检查后诊断为高促性腺激素性性腺功能减退症,进一步完善染色体核型分析后明确诊断为Klinefelter综合征。给予睾酮替代治疗及雌激素受体拮抗剂治疗后乳腺发育明显缓解。结论Klinefelter综合征早期诊断率低。早期诊断、及时的睾酮替代治疗对提高患者生活质量有积极影响。临床医师需要加强对Klinefelter综合征的认识。