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新生儿lateral meningocele综合征一例并文献复习

Neonatal lateral meningocele syndrome: report of a case and literature review

摘要目的:总结lateral meningocele综合征(lateral meningocele syndrome,LMS)的临床特点及其致病基因。方法:回顾性收集2020年5月在温州医科大学附属第二医院新生儿科确诊的1例LMS患儿的临床表现、实验室检查、影像学检查及基因检测结果等病例资料。以“lateral meningocele综合征”“侧脊膜膨出综合征”“ NOTCH3变异”和“lateral meningocele syndrome”“ NOTCH3”为检索词分别在中国知网数据库、万方数据库、维普数据库和在线人类孟德尔遗传数据库及PubMed进行文献检索(自建库至2021年2月)。结合本例患儿总结LMS的临床表现、致病机制和遗传学病因。 结果:本例患儿,男,7日龄,因“生后吃奶差1周”收入院。患儿表现为四肢肌张力低下、吞咽困难、高血压、侧脊膜膨出,伴有特殊面容和隐睾。脊柱MRI及脑干诱发电位均异常。全外显子组测序发现位于染色体19p13.12的 NOTCH3基因杂合移码变异c.6667_6686del(p.Ala2223Profs*12),未检测到父母携带该致病变异。文献检索到相关病例报道12篇(均为英文),包括15个家系共17例患者(其中基因确诊9例),连同本例患儿共18例(基因确诊共10例)。诊断年龄为15 d~55岁,均存在胸腰椎内多个侧脊膜膨出,常见表现为小下颌畸形和低位耳(16/18)、上睑下垂及眼睑下裂(15/18)、肌张力低下(13/18)、高血压(11/18)、发育迟缓(9/18)、混合性或传导性听力损失(9/18)、心血管发育异常(7/18)及男性隐睾(7/10)。共检出9种 NOTCH3基因变异,均为杂合变异,其中移码变异6种、无义变异3种。 结论:LMS的致病原因是 NOTCH3基因变异,主要表现为胸腰椎内多个侧脊膜膨出、颅面畸形、高血压、肌张力低下、发育迟缓、喂养困难和隐睾等。

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abstractsObjective:To investigate the clinical characteristics and pathogenic gene mutation of lateral meningocele syndrome(LMS).Methods:We retrospectively collected the clinical manifestations, laboratory examination, imaging examinations, and genetic analysis of a neonate with LMS which was diagnosed at the Department of Neonatology of the Second Affiliated Hospital of Wenzhou Medical University in May 2020. Relevant literature up to February 2021, retrieved from PubMed, OMIM, CNKI, Wanfang, and CQVIP database with the terms of "lateral meningocele syndrome", " NOTCH3", were reviewed to summarize the clinical characteristics, pathogenesis, and genetic etiology of this disease. Results:A full-term male newborn was admitted to our hospital due to feeding difficulty 7 d after birth. The clinical characteristics included hypotonia, dysphagia, hypertension, lateral spinal meningocele, craniofacial anomaly, and cryptorchidism. Abnormal spinal MRI and brainstem evoked potential were also observed. Whole exome sequencing revealed a heterozygous frameshift variation c.6667_6686del(p.Ala2223Profs*12) of NOTCH3 gene located in 19p13.12, which was not detected in the parents. Only 12 English literature were retrieved, with 17 patients from 15 pedigrees. Out of the 18 patients including the index case, 10 were genetically diagnosed as LMS. The age at diagnosis ranged from 15 d to 55 years. Regarding the clinical features, multiple lateral thoracolumbar spinal meningoceles (18/18) was the most common one, followed by retrognathia and low-set ears (16/18), eyelid ptosis and down slanting palpebral fissures (15/18), hypotonia (13/18), hypertension (11/18), developmental delay (9/18), mixed or conductive hearing loss (9/18), cardiovascular dysplasia (7/18), and cryptorchidism (7/10). A total of nine NOTCH3 gene variants were detected, all were heterozygous variants, including six frameshift and three nonsense variants. Conclusions:LMS is caused by NOTCH3 gene mutation with the clinical characteristics including multiple lateral thoracolumbar spinal meningoceles, craniofacial dysmorphisms, hypotonia, hypertension, developmental delay, difficulty in feeding, cryptorchidism, etc.

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