在家族性高胆固醇血症患者中,与复合LDLR基因突变相关的可变表型:病例序列和临床影响
Noor Alicezah Mohd Kasim1,2, Yung-An Chua1,3, Siti Hamimah Sheikh Abdul Kadir1,3
1Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Selangor, Malaysia.
Medicine
|February 27, 2026
概括
同胞性家族性高胆固醇血症 (HoFH) 可能由于化合物LDL受体 (LDLR) 突变而表现出不同的症状. 在第18个外显子中的新型LDLR变异可能导致HoFH患者的较轻的高胆固醇血症和不典型的临床特征.
科学领域:
- 遗传学 是一个遗传学.
- 心脏病学 心脏病学
- 生物化学 生化学
背景情况:
- 同胞性家族性高胆固醇血症 (HoFH) 是一种罕见的遗传疾病,其特征是极高的LDL胆固醇 (LDL-C) 和早发性心血管疾病.
- 它通常是由LDL受体 (LDLR) 基因的突变引起的,导致LDL-C清除受损.
- 本报告详细介绍了两例与复合LDLR突变无关的HoFH病例,呈现出不典型的临床表现.
研究的目的:
- 报告两个具有复合LDLR突变的HoFH罕见病例.
- 为了研究这些患者的基因型-表型相关性.
- 为了强调认识到HoFH表现的变化的重要性.
主要方法:
- 通过家族级联和常规查来识别病例.
- 综合性脂质分析. 综合性脂质分析.
- 与FH相关的基因的下一代测序,包括LDLR,APOB,PCSK9,ABCG5和ABCG8.
- 根据ACMG指南对新型LDLR变异的分类.
主要成果:
- 在第18个异构体中发现了两种新型化合物LDLR变体:c.2548-1_2548delGAinsTC (致病性) 和c.2556_2557insTCAGTCTGG (p.Leu853Serfs*12;可能致病性).
- 案例1对两种变异均为同卵性;案例2对拼接位变异均为同卵性,对位变异异为异卵性.
- 尽管有双性LDLR变异,但这两位患者都表现出相对较轻的高胆固醇血症,并且缺乏像肌桑托马等经典的HoFH污名.
结论:
- 影响细胞质尾部的第18个外显子中的LDLR变异可能与HoFH的减弱临床表达有关.
- 在HoFH中,基因型-表型变异性需要仔细考虑,以准确诊断和管理.
- 个性化风险分层和治疗策略对于患有HoFH的患者至关重要.
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