论著
ENGLISH ABSTRACT
重庆地区17 926例育龄女性脊髓性肌萎缩症携带者筛查及产前诊断分析
陈霞
高洋
陈文红
罗幸
童珂雅
作者及单位信息
·
DOI: 10.3760/cma.j.cn511374-20240808-00431
Carrier screening and prenatal diagnosis for Spinal muscular atrophy in 17 926 women of reproductive age in Chongqing
Chen Xia
Gao Yang
Chen Wenhong
Luo Xing
Tong Keya
Authors Info & Affiliations
Chen Xia
Center for Reproductive Medicine, Chongqing Health Center for Women and Children (Women and Children′s Hospital of Chongqing Medical University), Chongqing 400013, China
Gao Yang
Center for Reproductive Medicine, Chongqing Health Center for Women and Children (Women and Children′s Hospital of Chongqing Medical University), Chongqing 400013, China
Chen Wenhong
Center for Reproductive Medicine, Chongqing Health Center for Women and Children (Women and Children′s Hospital of Chongqing Medical University), Chongqing 400013, China
Luo Xing
Center for Reproductive Medicine, Chongqing Health Center for Women and Children (Women and Children′s Hospital of Chongqing Medical University), Chongqing 400013, China
Tong Keya
Center for Reproductive Medicine, Chongqing Health Center for Women and Children (Women and Children′s Hospital of Chongqing Medical University), Chongqing 400013, China
·
DOI: 10.3760/cma.j.cn511374-20240808-00431
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摘要

目的筛查重庆地区育龄女性脊髓性肌萎缩症(SMA)携带者频率,并对高风险夫妇行产前诊断分析。

方法选取2021年5月至2023年11月就诊于重庆市妇幼保健院的17 926例育龄女性为研究对象,包括3 398例孕前女性和14 528例孕妇,均无SMA表型及相关疾病家族史。采用实时荧光定量PCR(RT-qPCR)方法检测受试者 SMN1基因第7、8外显子(E7、E8)的拷贝数,筛选出高风险夫妇,采用多重连接探针扩增技术(MLPA)对产前高风险夫妇胎儿进行产前诊断。本研究已通过重庆市妇幼保健院医学伦理委员会审查[批准号:2021伦审(研)2021-RGI-02号]。

结果①17 926例育龄女性中,298例(1.66%)存在杂合缺失,其中278例(1.55%)E7、E8同时缺失,20例(0.11%)E7单独缺失。②检出高风险夫妇7对,其中产前高风险夫妇6对,经MLPA检出2例胎儿 SMN1基因E7、E8杂合缺失,4例胎儿未见异常。

结论上述研究成果揭示了重庆地区育龄女性的SMA携带频率,为该地区SMA的一、二级出生缺陷防控提供参考依据。

脊髓性肌萎缩症;携带者筛查;实时荧光定量PCR;产前诊断;女性
ABSTRACT

ObjectiveTo assess the carrier frequency of spinal muscular atrophy (SMA) in women of childbearing age in Chongqing and to evaluate prenatal diagnostic outcomes in high-risk couples.

MethodsA total of 17 926 women of childbearing age attending Chongqing Health Center for Women and Children between May 2021 and November 2023 were enrolled, including 3 398 pre-pregnant women and 14 528 pregnant women, all of whom had no clinical phenotype or family history of SMA or related neuromuscular disorders. Real-time quantitative PCR (RT-qPCR) was used to determine the copy number variations in exons 7 and 8 (E7, E8) of the SMN1 gene. High-risk carriers were identified based on the genetic screening results. Multiplex ligation-dependent probe amplification (MLPA) was employed for prenatal diagnosis of fetuses from high-risk couples. This study was approved by the Medical Ethics Committee of Chongqing Health Center for Women and Children (Ethics No.2021-RGI-02).

Results① Among the 17 926 women of childbearing age, 298 (1.66%) were identified as heterozygous carriers, including 278 (1.55%) with concurrent deletions of E7 and E8, and 20 (0.11%) with isolated deletions of E7. ② Seven high-risk couples were identified, six of whom were prenatal couples. Of the two fetuses from these high-risk pregnancies, both exhibited heterozygous deletions of E7 and E8 in the SMN1 gene, while four fetuses showed no abnormalities.

ConclusionThis study provides a comprehensive assessment of the carrier frequency of SMA among women of childbearing age in Chongqing, offering valuable data for the primary and secondary prevention of SMA-related birth defects in the region.

Spinal muscular atrophy;Carrier screening;Real-time fluorescence quantitative PCR;Prenatal diagnosis;Women
Tong Keya, Email: mocdef.qabq442595687
引用本文

陈霞,高洋,陈文红,等. 重庆地区17 926例育龄女性脊髓性肌萎缩症携带者筛查及产前诊断分析[J]. 中华医学遗传学杂志,2025,42(02):180-186.

DOI:10.3760/cma.j.cn511374-20240808-00431

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脊髓性肌萎缩症(spinal muscular atrophy,SMA)是以脊髓前角α运动细胞和脑干运动性脑神经核进行性变性为主要特征的一类具有严重致死性的常染色体隐性遗传性运动神经肌肉病,其人群发病率为1/10 000~1/6 000,携带率为1/60~1/40 [ 1 ]。SMA典型临床特征以肢体近端和躯干进行性、对称性肌肉无力和萎缩为特点,近端重于远端,下肢重于上肢,随着病情发展可出现多系统受累,严重时可导致呼吸衰竭甚至死亡 [ 2 , 3 ]。根据起病年龄、运动里程碑、临床表现及自然病程可将SMA分为5个亚型(0~Ⅳ型),各亚型之间在疾病进展及预后上存在较大差异 [ 4 ]。其中以Ⅰ、Ⅱ型最为常见,通常起病于婴幼儿期,一般存活不超过2岁。
SMA的发病机制主要由运动神经元存活基因1(survival motor neuron gene 1, SMN1)纯合缺失或者复合杂合变异引起的SMN蛋白缺乏或功能缺陷所致 [ 5 ]SMN1基因位于染色体5q13.2区,在全身组织均有表达,其中脊髓运动神经元中的表达量最高 [ 6 ]。在Ⅰ~Ⅲ型SMA患者中,95%~98%由 SMN1基因第7、8外显子(E7、E8)纯合缺失所致,其中大部分为E7、E8共同缺失,小部分为E7单独缺失;2%~5%由 SMN1基因微小变异等其他原因所致 [ 4 ]SMN1基因外显子缺失或其他大部分变异均会导致剪接异常,产生不稳定的SMN蛋白并被迅速降解,进而引发神经系统损害和多系统受累的临床表现 [ 7 ]。运动神经元存活基因2(survival motor neuron gene 2, SMN2)是SMA的修饰基因,与 SMN1基因高度同源。当 SMN1基因缺失时, SMN2基因也可表达少量完整的SMN蛋白,因此 SMN2基因的拷贝数与SMA病情呈负相关 [ 8 ]
由于SMA患者病情严重、危害大、死亡率高、治疗费用昂贵,SMA携带者筛查长期备受关注。2008年,美国医学遗传学与基因组学学会(American College of Medical Genetic,ACMG)建议SMA携带者筛查适用于任何种族 [ 9 ]。2016年,美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)建议所有计划怀孕或已怀孕女性应接受SMA携带者筛查 [ 10 ]。若夫妻双方均为SMA携带者,其后代存在25% SMA风险可能性,推荐通过胚胎植入前单基因遗传病检测(preimplantation genetic testing for monogenic diseases,PGT-M)及产前诊断进行出生缺陷防控。本研究采用实时荧光定量PCR(real-time fluorescence quantitative PCR,RT-qPCR)方法进行携带者筛查,以确定重庆地区育龄女性SMA携带率;同时采用多重连接探针扩增技术(multiplex ligation-dependent probe amplification,MLPA)对高风险夫妇行产前诊断,从而有效避免SMA患儿的出生 [ 11 ]。现将研究结果报道如下。
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备注信息
A
童珂雅,Email: mocdef.qabq442595687
B

陈霞:实验设计、实验实施、收集并整理数据、撰写论文、论文修改;高洋:获取研究经费、行政、技术或材料支持;陈文红:对文章的知识性内容作批评性审阅;罗幸:指导、支持性贡献;童珂雅:收集并整理数据、统计分析、对文章的知识性内容作批评性审阅、论文修改

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重庆市自然科学基金面上项目资助 (CSTB2022NSCQ-MSX0253)
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