遗传性 Alpha-Tryptasemia 的临床特征--对跨学科实践的影响。

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Dagmar von Bubnoff, Daniel Koch, Hannah Stocker, Ralf J Ludwig, Friederike Wortmann, Nikolas von Bubnoff
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引用次数: 0

摘要

背景:遗传性α-胰蛋白酶血症(HAT)是一种常染色体显性遗传易感基因,会导致基础血清胰蛋白酶(BST)浓度高度正常(≥ 8-11.4 μg/L)或病理性升高(>11.4 μg/L)。据报道,该病在英国和法国的发病率为 5%-6%;在德国的发病率尚不清楚。有症状的 HAT 患者会出现一系列复杂的症状。正如本综述所述,HAT 是跨学科实践中的一个重要鉴别诊断:本综述基于在 PubMed 上选择性搜索到的有关 HAT 的出版物、科学会议上的相关演讲以及我们的临床经验。我们还收集了自己关于 HAT 发病率和临床表现的数据:文献显示,HAT 在 BST 值为 8 μg/L 或以上的医疗中心患者中非常常见(64%-74%)。HAT 最常见的症状是神经精神症状,如疲惫(85%)、抑郁发作(59%)、睡眠障碍(69%)和记忆障碍(59%-68%),其次是胃肠道症状,如肠易激(30%-60%)、恶心(51%)和反流(49%-77%)。典型的肥大细胞介导的症状也有报道,如潮红(47%)、瘙痒(69%)、荨麻疹(37%)和过敏性休克(14%-28%)。较少见的是心血管表现,如肌力减退、头晕、心动过速(34%)和关节活动过度(28%)。HAT在浆液性肥大细胞增多症(SM;12%-21%)患者中更为常见。它通常与昆虫毒素或未知诱因引起的严重过敏性休克有关。治疗方案包括抗组胺药、肥大细胞稳定剂或 IgE 抗体:结论:在全面询问病史和测量 BST 的基础上,可以强烈怀疑遗传性α-色氨酸血症的诊断,然后通过分子基因检测进行确诊。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Clinical Features of Hereditary Alpha-Tryptasemia.

Background: Hereditary alpha-tryptasemia (HAT) is a genetic predisposition of autosomal dominant inheritance that leads to a high normal (≥ 8-11.4 μg/L) or pathologically elevated (>11.4 μg/L) basal serum tryptase (BST) concentration. Its prevalence in the United Kingdom and France is reportedly 5%-6%; its prevalence in Germany is unknown. Symptomatic persons with HAT suffer from a complex constellation of symptoms. As described in this review, HAT is an important differential diagnosis in interdisciplinary practice.

Methods: This review is based on publications about HAT retrieved by a selective search in PubMed, on relevant presentations at scientific meetings, and on our clinical experience. We also collected our own data on the prevalence and clinical manifestations of HAT.

Results: According to the literature, HAT is very common among patients in medical centers with BST values of 8 μg/L or above (64-74%). HAT is most commonly associated with neuropsychiatric symptoms such as exhaustion (85%), depressive episodes (59%), sleep disturbances (69%), and memory impairment (59%-68%), followed by gastrointestinal symptoms such as irritable bowel (30%-60%), nausea (51%), and reflux (49%-77%). Typical mast cell-mediated symptoms, such as flushing (47%), itch (69%), urticaria (37%), and anaphylaxis (14%-28%), are reported as well. Less commonly reported are cardio vascular manifestations, such as hypotonia, dizziness, and tachycardia (34%), and joint hyper - mobility (28%). HAT is more common among patients with systemic mastocytosis (SM; 12%-21%). It is often associated with severe anaphylaxis induced by insect toxins or unknown triggers. The therapeutic options include treatment with antihistamines, mastcell stabilizers, or IgE antibodies.

Conclusion: A diagnosis of hereditary alphatryptasemia can be strongly suspected on the basis of thorough history-taking and BST measurement and then confirmed by molecular genetic testing.

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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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