A SHOX géndeletio előfordulása idiopáthiás alacsonynövésben. Multicentrikus tanulmány | The prevalence of SHOX gene deletion in children with idiopathic short stature.A multicentric study

Absztrakt: Bevezetes: A SHOX gen izolalt haploinsufficientiaja az alacsonynovest okozo monogenes elvaltozasok leggyakoribb oka. A gen heterozigota elterese az idiopathias alacsonynovessel (ISS) diagnosztizalt betegek 2–15%-aban, Leri–Weill-dyschondrosteosis szindroma (LWS) 50–90%-aban, valamint a Turner-szindromaban szenvedők csaknem 100%-aban igazolhato. Celkitűzes: A SHOX gen haploinsufficientiaja gyakorisaganak meghatarozasa ISS-sel es LWS-sel diagnosztizalt, valamint Turner-fenotipusu, de normalis karyotypussal rendelkező betegek (TF) koreben, valamint beazonositani a SHOX genelteresre jellemző dysmorphias jeleket. Modszer: Osszesen 144 betegben kerult sor a SHOX gen haploinsufficientia-vizsgalatara multiplex ligatios proba Amplifikacio (MLPA) modszerrel. A betegek klinikai adatai (auxologiai parameterek, csontrendszeri rendellenessegek, dysmorphias tunetek) es a pozitiv genotipus kozotti osszefuggeseket statisztikai modszerekkel elemeztek. Eredmenyek: A vizsgalt 144 betegből 11 (7,6%) eseteben igazolodott SHOX genelteres, női dominanciaval (8/11, 81%). A SHOX-pozitiv betegeknek szignifikansan magasabb volt a testtomegindexe (BMI) (5/11-ből vs. 20/133-bol mutatott emelkedett erteket, p<0,02), es gyakoribbak voltak a dysmorphias tunetek (9/11 vs. 62/133, p = 0,02). A felső vegtagokon megjelenő Madelung-deformitas SHOX-pozitiv betegek kozott szinten szignifikansan gyakrabban fordult elő (4/11, 36% vs. 14/133, 10%, p = 0,0066), mint a SHOX-negativakban, de a vizsgalatkori eletkor, az alacsonynoves merteke, valamint az auxologiai meresek alapjan szamolt testaranyok nem mutattak statisztikailag kimutathato kulonbseget a ket csoport kozott. Kovetkeztetesek: A SHOX gen haploinsufficientiajanak előfordulasi gyakorisaga a vizsgalt betegpopulacionkban megegyezik az irodalmi adatokkal. SHOX-pozitiv esetekben, az idiopathias alacsonynoves mellett, a dysmorphias elvaltozasok pozitiv prediktiv ertekkel birnak a SHOX genelvaltozasok fennallasara. Ugyanakkor a dysmorphias jegyet nem mutato, de genetikailag pozitiv eset arra utal, hogy a SHOX gen vizsgalata indokolt dysmorphias tunetet nem mutato idiopathias alacsonynoves eseten is. Orv Hetil. 2017; 158(34): 1351–1356. | Abstract: Introduction: The isolated haploinsufficiency of the SHOX gene is one of the most common cause of short stature determined by monogenic mutations. The heterozygous deviation of the gene can be detected in 2–15% of patients with idiopathic short stature (ISS), in 50–90% of patients with Leri-Weill dyschondrosteosis syndrome (LWS), and in almost 100% of patients with Turner syndrome. Aim: The aim of our study was to evaluate the frequency of SHOX gene haploinsufficiency in children with ISS, LWS and in patients having Turner syndrome phenotype (TF), but normal karyotype, and to identify the dysmorphic signs characteristic for SHOX gene deficiency. Method: A total of 144 patients were included in the study. Multiplex Ligation-dependent Probe Amplification (MLPA) method was used to identify the SHOX gene haploinsufficiency. The relationships between clinical data (axiological parameters, skeletal disorders, dysmorphic signs) and genotype were analyzed by statistical methods. Results: 11 (7.6%) of the 144 patients showed SHOX gene deficiency with female dominance (8/11, 81% female). The SHOX positive patients had a significantly higher BMI (in 5/11 vs. 20/133 cases, p<0.02) and presented more frequent dysmorphic signs (9/11vs 62/133, p = 0.02). Madelung deformity of the upper limbs was also significantly more frequent among the SHOX positive patients (4/11, i.e. 36%, vs. 14/133, i.e. 10%, p = 0.0066). There were no statistically significant differences between the mean age, mean height and auxological measurements (sitting height/height, arm span/height) between the two groups of patients. Conclusions: The occurrence of SHOX gene haploinsufficiency observed in our population corresponds to the literature data. In SHOX positive patients, in addition to short stature, the dysmorphic signs have a positive predictive value for SHOX gene alterations. However, the SHOX deletion detected in a patient with idiopathic short stature without dysmorphic signs suggest that SHOX deletion analysis can be recommended in patients with ISS. Orv Hetil. 2017; 158(34): 1351–1356.