Ⅵ型胶原肌膜选择性缺失型Ullrich型先天性肌营养不良临床及免疫病理特点

摘要

目的 探讨Ⅵ型胶原肌膜选择性缺失型Ullrich型先天性肌营养不良(Ullrich congenital muscular dystrophy,UCMD)的临床和免疫病理特点.方法 收集2例Ⅵ型胶原肌膜选择性缺失型UCMD患者的临床资料,进行肌肉活体组织检查,标本行Ⅵ型胶原免疫荧光染色和Ⅵ型胶原/Ⅳ型胶原双重免疫荧光染色,对病理结果进行分析.结果 新生儿肌张力低下、近端关节挛缩和远端关节弹性过度是Ⅵ型胶原肌膜选择性缺失型UCMD的临床特点.抗Ⅵ型胶原免疫荧光染色提示2例患者均为Ⅵ型胶原表达部分缺失.Ⅵ型胶原/Ⅳ型胶原双重免疫荧光染色可见肌膜Ⅵ型胶原表达选择性缺失.结论 Ⅵ型胶原肌膜选择性缺失型UCMD以近端关节挛缩和远端关节弹性过度为临床特征,临床严重度和Ⅵ型胶原完全缺失者没有显著差异.双重免疫荧光染色提示Ⅵ型胶原在肌膜上表达选择性缺失是其免疫病理特点.%Objective To investigate the clinical and immune pathological features of Ullrich congenital muscular dystrophy (UCMD) with sarcolemma-specific collagen Ⅵ deficiency (SSCD). Methods The clinical aspects of 2 patients with SSCD were analyzed and the muscle specimens from them were studied by immunofluorescence. Results SSCD patients were clinically characterized by neonatal hypotonia with proximal contractures and distal hyperlaxity at birth or early infancy. Immunofluorescence staining revealed partial deficiency of collagen Ⅵ. Double immunofluorescence staining revealed sarcolemma-specific deficiency of collagen Ⅵ, while collagen Ⅳ intact in thesarcolemma. Conclusions The clinical picture and severity of UCMD with SSCD are similar to the cases with collagen Ⅵ complete deficiency. The proximal contractures and distal hyperlaxity are the clinical hallmarks of both types. Sarcolemma-specific collagen Ⅵ deficiency can be better demonstrated by double immunofluorescence staining.