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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 520 -525. doi: 10.3877/cma.j.issn.1674-3253.2021.06.016

临床研究

53例性别发育异常患者靶向二代测序结果分析及临床应用
郭强1, 钟文文1, 叶雷1, 刘碧好1, 马波1, 尧冰1, 瞿虎1, 赖华健1, 汪中扬1, 邱剑光1, 王德娟1,()   
  1. 1. 510655 广州,中山大学附属第六医院泌尿外科
  • 收稿日期:2021-04-27 出版日期:2021-12-01
  • 通信作者: 王德娟
  • 基金资助:
    广东省自然科学基金(2019A1515010386); 广东省医学科学技术研究基金(A2020212); 广东省医学科学技术研究基金(A2019247)

Analysis and clinical application of targeted next-generation sequencing in 53 patients with disorders of sex development

Qiang Guo1, Wenwen Zhong1, Lei Ye1, Bihao Liu1, Bo Ma1, Bing Yao1, Hu Qu1, Huajian Lai1, Zhongyang Wang1, Jianguang Qiu1, Dejuan Wang1,()   

  1. 1. Department of Urology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
  • Received:2021-04-27 Published:2021-12-01
  • Corresponding author: Dejuan Wang
引用本文:

郭强, 钟文文, 叶雷, 刘碧好, 马波, 尧冰, 瞿虎, 赖华健, 汪中扬, 邱剑光, 王德娟. 53例性别发育异常患者靶向二代测序结果分析及临床应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(06): 520-525.

Qiang Guo, Wenwen Zhong, Lei Ye, Bihao Liu, Bo Ma, Bing Yao, Hu Qu, Huajian Lai, Zhongyang Wang, Jianguang Qiu, Dejuan Wang. Analysis and clinical application of targeted next-generation sequencing in 53 patients with disorders of sex development[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(06): 520-525.

目的

探讨下一代靶向核基因组测序在拟诊性别发育异常(DSD)患者诊治中的应用。

方法

收集2017年7月至2020年7月收治的53例性别发育异常疑似患者资料,提取患者及其父母外周血DNA,运用含有141个靶向核基因组检测包对DSD患者进行下一代靶向核基因组检测,分析结果。

结果

53例DSD疑似患者中,检测出21例相关的染色体或基因变异,其中致病变异或可能致病变异13例,7例新发变异以及1例致病意义未明的变异,7例新发变异中2例被预测为致病变异,确诊率为28.3%(15/53)。检测阳性率为39.6%(21/53),所涉及的基因为SRD5A2,CHD7,AR,NR5A1,NSMF,MAP3K1,MAMLD1,ANOS1,含1例47,XXY性染色体DSD伴卵睾型DSD,20例46,XY DSD,其中20例经手术治疗。32例患儿存在相应的临床症状,但未检测出相应的遗传学变异,31例经手术治疗。

结论

靶向下一代核基因组测序提高了DSD疑似患者的早期确诊率,其结果对于治疗方案的选择具有指导意义。

Objective

To explore the application of next-generation targeted nuclear genome sequencing in the diagnosis and treatment of patients with suspected disorders of sex development (DSD).

Methods

The data of 53 suspected patients with DSD were admitted from July 2017 to July 2020, and the peripheral blood DNA of the patients and their parents were collected. The next generation of targeted nuclear genome sequencing of DSD patients was carried out using a panel containing 141 targeted nuclear genomes, and the results were analyzed.

Results

Among the 53 patients with suspected DSD, 21 cases of related chromosomal or gene variants were detected. Among them, 13 cases were pathogenic variants or likely pathogenic variants, 7 were novel variants, and 1 of uncertain significance. Two of the seven new variants were predicted as pathogenic variants, so the diagnosis rate was 28.3%(15/53). The positive rate was 39.6%(21/53), and the genes involved SRD5A2, CHD7, AR, NR5A1, NSMF, MAP3K1, MAMLD1, ANOS1, including 1 case 47, XXY DSD and ovotesticular DSD, and 20 cases 46, XY DSD, 20 of which were treated by surgery. 32 children had corresponding clinical symptoms, but no corresponding genetic variation was detected. 31 cases were treated with surgery.

Conclusion

Targeted next-generation nuclear genome sequencing improves the early diagnosis rate of suspected DSD patients, and the results can help for the choice of treatment.

表1 已知致病或可能致病变异的性别发育异常患儿总结
编号 年龄 临床症状 基因 遗传方式 HG19位置 转录本 核苷酸与氨基酸的改变 ACMG变异类型 杂合来源 相关文献
01 3岁 小阴茎,雄激素不足 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) LP 父亲+母亲 PMID:8784107/12843198
03 11岁 小阴茎 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) LP 父亲+母亲 PMID:8784107/12843198
14 1岁 尿道下裂,隐睾 47,XXY - chrX - XXY LP - PMID:20531999/26664093
15 1岁 小阴茎,尿道下裂,听力损失 AR XL chrX:66937416 NM_000044 c.2270A>G(p.N757S) P 母亲 PMID:22412043/11422119
16 12岁 小阴茎,隐睾 SRD5A2 AR chr2:31805911 NM_000348 c.59T>C(p.L20P) P 母亲 PMID:8784107/12843198/18314109
          chr2:31754395 c.680G>A(p.R227Q) 父亲
23 7岁 小阴茎 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) P 父亲+母亲 PMID:8784107
26 1岁 小阴茎 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) P 母亲 PMID:8784017/19492581/10718838
          chr2:31751294 c.737G>A(p.R246Q) LP 父亲
29 3岁 小阴茎 SRD5A2 AR chr2:31754468 NM_000348 c.607G>A(p.G203S) P 父亲 PMID:9135696/18314109/8784107/28663096/10898110
          chr2:31754395 c.680G>A(p.R227Q)   母亲
      NR5A1 AD/AR chr9:127245044 NM_004959 c.1379A>T(p.Q460L) VUS - PMID:28938747
31 3岁 尿道下裂 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) P 父亲 PMID:8487107/28663096
33 5岁 小阴茎,尿道下裂 SRD5A2 AR chr2:31754395 NM_000348 c.680G>A(p.R227Q) P 母亲 PMID:8784107/28663096
          chr2:31754468 c.607G>A(p.G203S) LP 父亲 PMID:9135696/31031332
35 3岁 小阴茎,隐睾,性腺发育不良 -   chr15   母源单亲异源二倍体(mUPD,heterodisomy) P 母亲 PMID:2812027/9972835/10711647/
44 11个月 小阴茎,尿道下裂 SRD5A2 AR chr2:31754468 NM_000348 c.607G>A(p.G203S) P 父亲 PMID:9135696/15266301/25899528/21540559/8784107/28663096
          chr2:31754395 c.680G>A(p.R227Q) 母亲
52 11岁 小阴茎 SRD5A2 AR chr2:31754536 NM_000348 c.548-9T>G LP 父亲 PMID:31186340
表2 新发突变中致病或可能致病基因的性别发育异常患儿的资料
表3 致病意义未明的变异基因的性别发育异常患儿的资料
图1 SRD5A2基因变异致5α还原酶缺乏症尿道下裂并阴茎体发育不良患者治疗过程(首诊半岁) 注:a为双氢睾酮治疗前;b为双氢睾酮治疗后;c为一期尿道下裂矫形术前;d一期尿道下裂矫形术后
表4 使用NGS对DSD进行诊断的研究汇总
表5 不同研究中DSD检测阳性率及诊断率的对比
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