血红蛋白H病复合非缺失型遗传性胎儿血红蛋白持续存在综合征44例临床分析

Clinical analysis of 44 hemoglobin H disease cases combined with non-deletional hereditary persistence of fetal hemoglobin

  • 摘要: 目的:探讨复合非缺失型遗传性胎儿血红蛋白持续存在综合征(nd-HPFH)对血红蛋白H病(Hb H病)的影响。方法:收集2022年1—12月在广西医科大学第一附属医院进行地中海贫血筛查诊断为Hb H病的患者148例,对研究对象进行血常规检查,采用高效液相色谱法进行血红蛋白(Hb)分析;DNA测序方法检测γ-珠蛋白基因突变;荧光PCR熔解曲线法和Gap-PCR法检测α-和β-地中海贫血基因突变。结果:148 例Hb H 病患者中,检出44 例复合nd-HPFH,检出率为29.7%, 基因突变类型为Gγ-158C> T突变杂合子27例,Aγ-225~-222缺失杂合子13例,Gγ-158C> T突变纯合子2例,Gγ-158C> T突变杂合子复合Aγ-225~-222缺失纯合子1例,Gγ-158C> T突变杂合子复合Aγ-225~-222缺失杂合子1例。Hb分析结果显示,1例胎儿血红蛋白(Hb F)升高,为5.3%;血常规检查结果:轻度贫血19例,中度贫血24例,重度贫血1例。地中海贫血基因检测结果:--SEACSα 20例、--SEA/-α3.7 13 例、--SEA/-α4.2 9例、--SEAQSα 1 例和--THAI/-α3.7 1 例。结论:nd-HPFH 基因突变在Hb H 病患者中有较高的检出率,nd-HPFH 复合Hb H病临床贫血表现存在差异;此类患者大多数Hb F正常,临床上容易漏诊。

     

    Abstract: Objective:To investigate the effect of compound heterozygous non-deletional hereditary persistence of fetal hemoglobin(nd-HPFH)on hemoglobin H disease(Hb H disease).Methods:A total of 148 patients diagnosed as Hb H disease by thalassemia screening in the First Affiliated Hospital of Guangxi Medical University from January 2022 to December 2022 were collected.Blood routine tests were performed on the subjects, and hemoglobin (Hb) analysis was performed by high performance liquid chromatography.DNA sequencing was used for detecting the mutation of γ-globin gene.Mutations of α-and β-thalassemia genes were detected by fluorescent PCR melting curve analysis and Gap-PCR methods.Results:Among 148 patients with Hb H disease, 44 cases with compound nd-HPFH were detected, the gene detection rate was 29.7%, including 27 cases ofGγ-158C> T mutant heterozygotes, 13 cases ofAγ-225 to-222 deletion heterozygotes, 2 cases ofGγ-158C> T mutant homozygotes, 1 case ofGγ-158C> T mutant heterozygote combined withAγ-225 to-222 deletion homozygote, 1 case ofGγ-158C> T mutant heterozygote combined withAγ-225 to-222 deletion heterozygote.The results of Hb analysis showed that 1 case had elevated fetal hemoglobin (Hb F)(5.3%).Blood routine results were as follows: 19 cases with mild anemia, 24 cases with moderate anemia and 1 case with severe anemia.Thalassemia genotyping results were as follows: 20 cases with--SEACSα, 13 cases with--SEA/-α3.7, 9 cases with--SEA/-α4.2, 1 case with--SEAQSα and 1 case with--THAI/-α3.7.Conclusion:The nd-HPFH mutation has a high detection rate in patients with Hb H disease, and there are differences in clinical anemia in patients with nd-HPFH combined with Hb H disease.Most of these patients have normal Hb F levels and are easy to be missed clinically.

     

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