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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

邮发代号 80-967

2019 Impact Factor: 3.421

Frontiers of Medicine  2018, Vol. 12 Issue (5): 550-558   https://doi.org/10.1007/s11684-017-0567-y
  本期目录
Clinical characterization and diagnosis of cystic fibrosis through exome sequencing in Chinese infants with Bartter-syndrome-like hypokalemia alkalosis
Liru Qiu, Fengjie Yang, Yonghua He, Huiqing Yuan, Jianhua Zhou()
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China
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Abstract

Cystic fibrosis (CF) is a fatal autosomal-recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. CF is characterized by recurrent pulmonary infection with obstructive pulmonary disease. CF is common in the Caucasian population but is rare in the Chinese population. The symptoms of early-stage CF are often untypical and may sometimes manifest as Bartter syndrome (BS)-like hypokalemic alkalosis. Therefore, the ability of doctors to differentiate CF from BS-like hypokalemic alkalosis in Chinese infants is a great challenge in the timely and accurate diagnosis of CF. In China, sporadic CF has not been diagnosed in children younger than three years of age to date. Three infants, who were initially admitted to our hospital over the period of June 2013 to September 2014 with BS-like hypokalemic alkalosis, were diagnosed with CF through exome sequencing and sweat chloride measurement. The compound heterozygous mutations of the CFTR gene were detected in two infants, and a homozygous missense mutation was found in one infant. Among the six identified mutations, two are novel point mutations (c.1526G>C and c.3062C>T) that are possibly pathogenic. The three infants are the youngest Chinese patients to have been diagnosed with sporadic CF at a very early stage. Follow-up examination showed that all of the cases remained symptom-free after early intervention, indicating the potential benefit of very early diagnosis and timely intervention in children with CF. Our results demonstrate the necessity of distinguishing CF from BS in Chinese infants with hypokalemic alkalosis and the significant diagnostic value of powerful exome sequencing for rare genetic diseases. Furthermore, our findings expand the CFTR mutation spectrum associated with CF.

Key wordscystic fibrosis    pseudo-Bartter syndrome    hypokalemic alkalosis    CFTR gene    mutations    infants    diagnosis
收稿日期: 2016-10-31      出版日期: 2018-09-29
Corresponding Author(s): Jianhua Zhou   
 引用本文:   
. [J]. Frontiers of Medicine, 2018, 12(5): 550-558.
Liru Qiu, Fengjie Yang, Yonghua He, Huiqing Yuan, Jianhua Zhou. Clinical characterization and diagnosis of cystic fibrosis through exome sequencing in Chinese infants with Bartter-syndrome-like hypokalemia alkalosis. Front. Med., 2018, 12(5): 550-558.
 链接本文:  
https://academic.hep.com.cn/fmd/CN/10.1007/s11684-017-0567-y
https://academic.hep.com.cn/fmd/CN/Y2018/V12/I5/550
Patient-1 (P-1) Patient-2 (P-2) Patient-3 (P-3)
Age/gender 6 months/female 4 months/male 6 months/female
Season of onset Summer Summer Summer
Failure to thrive Yes Yes Yes
Sinusitis No No No
Cough Yes No Yes
Polydipsia, polyuria Yes Yes Yes
Diarrhea No Occasional No
Hypertension No No No
Blood pH 7.713 7.531 7.669
Blood HCO3 (mmol/L) 43 36.4 29.8
Blood sodium (mmol/L) 120.1 104 105.6
Blood potassium (mmol/L) 2.48 1.50 3.07
Blood chloride (mmol/L) 64.7 68.6 57.9
Blood amylase and lipase Normal Normal Normal
Blood renin [ng/(mL·h)] 2.19↑ 10.26↑ 6.07↑
Blood angiotensin II (pg/mL) 859.13↑ 949.25↑ 981.03↑
Blood aldosterone (ng/mL) 19.42↑ 20.82↑ 18.70↑
Urine electrolytes Normal Normal Normal
Sputum culture Pseudomonas aeruginosa Negative Staphylococcus aureus
Lung X/CT Patchy lesion Patchy lesion Patchy lesion
Pancreas ultrasonography Normal Normal Normal
Sweat chloride (mmol/L) 123.4 115.37 143.71
Tab.1  
Infants Exon Nucleotide changes Amino acid changes Het/Hom Reported/novel Frequency in 100 healthy controls Frequency in 1000 human genome Software prediction Pathogenicity
P-1 Exon 8 c.1040G>A p.R347H Het (paternal) Reported 0 0 All detrimental CF-causing
Exon 25 c.4056G>C p.Q1352H Het (paternal) Reported 0 0 All detrimental CF-causing
Exon 11 c.1526G>C p.G509A Het (maternal) Novel 0 0 One harmless Unknown
P-2 Exon18 c.2909G>A p.G970D Hom (paternal and maternal) Reported 0 0 All detrimental Possibly pathogenic
P-3 Intron 8 c.1116+ 1G>A Het (maternal) Reported 0 0 All detrimental CF-causing
Exon 19 c.3062C>T p.P1021 L Het (paternal) Novel 0 0 All detrimental Possibly pathogenic
Tab.2  
Fig.1  
Fig.2  
Fig.3  
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