
66日龄婴儿发现多发皮下结节1月余
Multiple subcutaneous nodules for 46 days in an infant aged 66 days
患儿,男,66?d,因发现皮下结节46?d,腹胀10?d入院。患儿主要临床表现为全身脂肪组织减少,皮下结节,胰岛素抵抗型糖尿病,高三酰甘油血症,肝脂肪变性,最终确诊为先天性全身性脂肪代谢障碍1型。经改用含中链脂肪酸比例高的配方奶及先后予胰岛素注射、二甲双胍口服后病情好转。基因检测显示AGPAT2基因存在c.646A > T纯合突变,其父母均为该突变的携带者。该病例为国内报道的起病年龄最小、且以多发皮下结节为首发症状的先天性全身性脂肪代谢障碍1型患儿。
A boy, aged 66 days, was admitted to the hospital due to subcutaneous nodules for 46 days and abdominal distension for 10 days. The main clinical manifestations were loss of adipose tissue, subcutaneous nodules, insulin-resistant diabetes, hypertriglyceridemia, and hepatic steatosis. The boy was diagnosed with congenital generalized lipodystrophy type 1 (CGL1). His condition was improved after administration of middle-chain fatty acid formula milk and insulin injection or oral metformin. Gene testing revealed a homozygous mutation, c.646A > T, in the AGPAT2 gene, and both his parents were carriers of this mutation. This case of CGL1 has the youngest age of onset ever reported in China and multiple subcutaneous nodules as the initial symptom.
先天性全身性脂肪代谢障碍 / 脂肪萎缩 / 糖尿病 / 高三酰甘油血症 / 新生儿
Congenital generalized lipodystrophy / Lipoatrophy / Diabetes mellitus / Hypertriglyceridemia / Neonate
[1] Grulich-Henn J, Wagner V, Thon A, et al. Entities and frequency of neonatal diabetes:data from the diabetes documentation and quality management system (DPV)[J]. Diabet Med, 2010, 27(6):709-712.
[2] Lemelman MB, Letourneau L, Greeley SAW. Neonatal diabetes mellitus:an update on diagnosis and management[J]. Clin Perinatol, 2018, 45(1):41-59.
[3] Russo L, Iafusco D, Brescianini S, et al. Permanent diabetes during the first year of life:multiple gene screening in 54 patients[J]. Diabetologia, 2011, 54(7):1693-1701.
[4] Richards S, Aziz N, Bale S, et al. Standards and guidelines for the interpretation of sequence variants:a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology[J]. Genet Med, 2015, 17(5):405-424.
[5] Akinci B, Onay H, Demir T, et al. Natural history of congenital generalized lipodystrophy:a nationwide study from Turkey[J]. J Clin Endocrinol Metab, 2016, 101(7):2759-2767.
[6] Lima JG, Nobrega LH, de Lima NN, et al. Clinical and laboratory data of a large series of patients with congenital generalized lipodystrophy[J]. Diabetol Metab Syndr, 2016, 8:23.
[7] Patni N, Garg A. Congenital generalized lipodystrophies-new insights into metabolic dysfunction[J]. Nat Rev Endocrinol, 2015, 11(9):522-534.
[8] Garg A. Acquired and inherited lipodystrophies[J]. N Engl J Med, 2004, 350(12):1220-1234.
[9] Liu Y, Li D, Ding Y, et al. Further delineation of AGPAT2 and BSCL2 related congenital generalized lipodystrophy in young infants[J]. Eur J Med Genet, 2019, 62(9):103542.
[10] Lima JG, Nobrega LHC, Lima NN, et al. Causes of death in patients with Berardinelli-Seip congenital generalized lipodystrophy[J]. PLoS One, 2018, 13(6):e0199052.
[11] Hussain I, Garg A. Lipodystrophy syndromes[J]. Endocrinol Metab Clin North Am, 2016, 45(4):783-797.
[12] Garg A. Lipodystrophies[J]. Am J Med, 2000, 108(2):143-152.
[13] Ceccarini G, Magno S, Pelosini C, et al. Congenital generalized lipoatrophy (Berardinelli-Seip syndrome) type 1:description of novel AGPAT2 homozygous variants showing the highly heterogeneous presentation of the disease[J]. Front Endocrinol (Lausanne), 2020, 11:39.
[14] Cautivo KM, Lizama CO, Tapia PJ, et al. AGPAT2 is essential for postnatal development and maintenance of white and brown adipose tissue[J]. Mol Metab, 2016, 5(7):491-505.
[15] Papendieck L, Araujo MB. Clinical outcome in a series of pediatric patients with congenital generalized lipodystrophies treated with dietary therapy[J]. J Pediatr Endocrinol Metab, 2018, 31(1):77-83.
[16] Tchang BG, Shukla AP, Aronne LJ. Metreleptin and generalized lipodystrophy and evolving therapeutic perspectives[J]. Expert Opin Biol Ther, 2015, 15(7):1061-1075.
[17] Araujo-Vilar D, Sánchez-Iglesias S, Guillín-Amarelle C, et al. Recombinant human leptin treatment in genetic lipodystrophic syndromes:the long-term Spanish experience[J]. Endocrine, 2015, 49(1):139-147.
[18] Brown RJ, Oral EA, Cochran E, et al. Long-term effectiveness and safety of metreleptin in the treatment of patients with generalized lipodystrophy[J]. Endocrine, 2018, 60(3):479-489.