基于高通量测序分析鉴别视网膜病变中的神经纤维瘤病OA
Identification of neurofibromatosis in retinopathy based on high-throughput sequencing analysis
目的:通过高通量测序分析进行基因诊断,鉴别视网膜病变中的神经纤维瘤病,为其早诊早治提供重要依据.方法:回顾性分析眼遗传病高通量测序数据库中的NF1和NF2基因变异,根据ACMG/AMP指南解析变异致病性;进一步结合患者的临床表型、家族史以及其他检查结果,综合判断明确是否患有神经纤维瘤病,同时进行疾病的进展和随访的研究分析.结果:通过分析不同眼部表型家系的高通量测序结果,共在11例先证者中发现NF1和NF2基因的10个可能致病变异,包括7个NF1变异和3个NF2变异.这11例先证者的初始诊断包括家族性渗出性玻璃体视网膜病变、黄斑/视网膜发育不良、斜视、视网膜色素变性、Coats病和牵牛花综合征等.其中,在1例初诊为家族性渗出性玻璃体视网膜病变的患儿中,检测到3个基因的致病变异,即NF2:c.122G＞A/p.(W41*)、RS1:c.520C＞T/p.(R174W)和NYX:c.1027C＞T/p.(R343C).随访检查发现,该患儿的复杂眼部表型符合NF2、RS1和NYX致病变异的临床改变,且MRI检查发现双侧前庭神经鞘瘤、脊髓室管膜瘤和多发性神经鞘瘤改变.除该患者外,还有4例患者在随访中发现存在牛奶咖啡斑或雀斑样色素沉着等皮肤改变,1 例合并小脑神经纤维瘤浸润.结论:高通量测序分析能有效检测出神经纤维瘤病相关基因的变异,有助于筛选非典型表现的神经纤维瘤病,为疾病的早期诊断,尤其是对严重中枢神经系统病变的早期筛查和及时干预,提供了重要依据.
Objective:To identify neurofibromatosis in retinopathy through high-throughput sequencing analysis and provide important indicators for early diagnosis and treatment.Methods:Variants in NF1 and NF2 were selected from in-house high-throughput sequencing,including targeted exome sequencing,exome sequencing and whole genome sequencing,of individuals with different eye conditions.Pathogenic or likely pathogenic variants were assessed according to ACMG/AMP criteria.All the available clinical data,including clinical manifestation,family history and other examination results,were summarized and further analyzed to determine whether neurofibromatosis.Results:Based on the results of in-house high-throughput sequencing,a total of ten pathogenic or likely pathogenic variants in NF1 and NF2 were identified in 11 unrelated cases with various eye conditions,including three NF2 variants in four cases and seven NF1 variants in seven cases.The unrelated cases with NF1 and NF2 variants had initial clinical manifestation similar to familial exudative vitreoretinopathy(FEVR),macular or retinal dystrophy,strabismus,retinitis pigmentosa,Coats disease,or morning glory syndrome.In one of these cases,who was diagnosed as FEVR at the initial visit,three pathogenic variants of three different genes were identified,namely NF2:c.122G＞A/p.(W41*),RS1:c.520C＞T/p.(R174W)and NYX:c.1027C＞T/p.(R343C).Follow-up examination on this case revealed a complex retinopathy,which were consistent with clinical presentations due to pathogenic variants in NF2,RS1,and NYX,as well as bilateral vestibular schwannomas,spinal ependymoma and multiple schwannomas by MRI.In addition to this patient,a follow-up examination on four of the seven cases present Café-au-lait macules or freckling,which could be easily neglected if neurofibromatosis is not realized on the initial visit,while one had neurofibromatosis in cerebellum.Conclusions:Complex retinopathy may present as the initial sign of neurofibromatosis,and high-throughput sequencing analysis for neurofibromatosis related genes contribute to early diagnosis of neurofibromatosis and facilitating early identification of vital systemic complication.
欧阳嘉敏;高阳;易珍;蒋奕;黎仕强;肖学珊;贾小云;张清炯;孙文敏
中山大学中山眼科中心,眼病防治全国重点实验室,广东省眼科视觉科学重点实验室,广州 510060
临床医学
神经纤维瘤病NF1NF2高通量测序视网膜病变
neurofibromatosisNF1NF2high-throughput sequencingretinopathy
《眼科学报》 2024 (008)
381-394 / 14
国家自然科学基金面上项目(82171056);广东省区域联合基金-青年基金项目(2022A1515111060);广州市科技计划项目(SL2024A03J00525);眼科学国家重点实验室专项经费.This work was supported by the National Natural Science Foundation of China(82171056);the Guangdong Basic and Applied Basic Research Foundation(2022A1515111060);the Science and Technology Planning Projects of Guangzhou(SL2024A03J00525);the Fundamental Research Funds of the State Key Laboratory of Ophthalmology.
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