目的 探讨原发性肉碱缺乏症(primary camitine deficiency,PCD)患者的临床特点和SLC22A5基因突变情况.方法 利用液相(色谱)串联质谱技术对徐州市2015年9月至2017年12月出生的210 908例新生儿和576例临床遗传代谢病疑似患儿进行游离肉碱及酰基肉碱检测,对游离肉碱降低的患儿进行SLC22A5基因突变分析以确诊.对确诊患儿的临床表现、生化特点、基因特点及治疗预后进行分析,并采用配对样本t检验对患儿治疗前后的生化指标进行比较.结果 共确诊10例PCD患儿(其中9例来自新生儿筛查,1例来自临床患儿)和7例母源性肉碱缺乏症患者,口服左卡尼汀治疗后血游离肉碱和其他酰基肉碱水平恢复正常.1例来自临床患儿的临床症状消失,16例来自新生儿筛查的患儿无任何临床症状,生长发育正常.17例患儿均进行基因突变检测,共检出10种突变类型,分别为c.1400C＞G、c.1462C＞T、c.797C＞T、c.95A＞G、c.92C＞T、c.1093A＞C、c.761G＞A、c.865C＞T、c.428C＞T、c.1195C ＞T,其中c.1093A＞C和c.92C＞T为新突变,c.1400C＞G为最常见的突变类型.结论 液相(色谱)串联质谱技术可筛查出新生儿及母源性肉碱缺乏症患者,徐州地区c.1400C＞G突变出现频率最高,早期治疗预后良好.%Objective To investigate the clinical features and SLC22A5 gene mutation types in patients with primary carnitine deficiency(PCD).Methods The free carnitine(CO) and acylcarnitine levels in the blood of 210 908 neonates from newborn screening program and 576 children with suspected clinical inherited metabolic diseases were measured by using liquid chromatography tandem mass spectrometry method during September 2015 to December 2017,after that the SLC22A5 gene mutations were analyzed in the children with low CO level and the diagnosis was made.The clinical characteristics,laboratory findings,genotypes,treatment and prognosis were retrospectively analyzed in patients.Paired sample t test was used to compare the biochemical indexes of patients before and after the treatments.Results Ten children were diagnosed with PCD(9 cases from newborn screening program,1 case from clinical patients),and 7 children were diagnosed with maternal carnitine deficiency.After treatment with oral Levocarnitine,the free carnitine and acylcarnitine of the patients returned to the normal levels.The clinical symptoms disappeared in 1 patient out of clinical patients,and the other 16 patients from newborn screening program were asymptomatic and showed normal growth and development.Seventeen patients got genetic analysis,and 10 types of mutations were found,including c.1400C ＞ G,c.1462C ＞ T,c.797C ＞ T,c.95A ＞ G,c.92C ＞ T,c.1093A ＞ C,c.761G ＞ A,c.865C ＞ T,c.428C ＞ T,c.1195C ＞ T,among which two of them (c.1093A ＞ C and c.92C ＞ T) were novel mutations.The most common mutation of SLC22A5 gene was c.1400C ＞ G.Conclusions Liquid chromatography tandem mass spectrometry technology is sufficient to screen newborns and maternal carnitine deficiency,and the c.1400C ＞ G mutation is found at the highest frequency in Xuzhou area.If patients receive early treatment,they may have a good prognosis.
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