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Zhong H, Zeng L, Yu X, Ke Q, Dong J, Chen Y, Luo L, Chang X, Guo J, Wang Y, Xiong H, Liu R, Liu C, Wu J, Lin J, Xi J, Zhu W, Tan S, Liu F, Lu J, Zhao C, Luo S. Clinical features and genetic spectrum of a multicenter Chinese cohort with myotonic dystrophy type 1. Orphanet J Rare Dis 2024; 19:103. [PMID: 38454488 PMCID: PMC10918885 DOI: 10.1186/s13023-024-03114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND As the most common subtype of adult muscular dystrophy worldwide, large cohort reports on myotonic dystrophy type I (DM1) in China are still lacking. This study aims to analyze the genetic and clinical characteristics of Chinese Han DM1 patients. METHODS Based on the multicenter collaborating effort of the Pan-Yangtze River Delta Alliance for Neuromuscular Disorders, patients with suspected clinical diagnoses of DM1 were genetically confirmed from January 2020 to April 2023. Peak CTG repeats in the DMPK gene were analyzed using triplet repeat-primed PCR (TP-PCR) and flanking PCR. Time-to-event analysis of onset age in females and males was performed. Additionally, detailed clinical features and longitudinal changes from the disease onset in 64 DM1 patients were retrospectively collected and analyzed. The Epworth Sleepiness Scale and Fatigue Severity Scale were used to quantify the severity of daytime sleepiness and fatigue. RESULTS Among the 211 genetically confirmed DM1 patients, the mean age at diagnosis was 40.9 ± 12.2 (range: 12-74) with a male-to-female ratio of 124:87. The average size of CTG repeats was 511.3 (range: 92-1945). Among the DM1 patients with comprehensive clinical data (n = 64, mean age 41.0 ± 12.0), the age at onset was significantly earlier in males than in females (4.8 years earlier, p = 0.026). Muscle weakness (92.2%), myotonia (85.9%), and fatigue (73.4%) were the most prevalent clinical features. The predominant involved muscles at onset are hands (weakness or myotonia) (52.6%) and legs (walking disability) (42.1%). Of them, 70.3% of patients had daytime sleepiness, 14.1% had cataract surgery, 7.8% used wheelchairs, 4.7% required ventilatory support, and 1.6% required gastric tubes. Regarding the comorbidities, 4.7% of patients had tumors, 17.2% had diabetes, 23.4% had dyspnea, 28.1% had intermittent insomnia, 43.8% experienced dysphagia, and 25% exhibited cognitive impairment. Chinese patients exhibited smaller size of CTG repeats (468 ± 139) than those reported in Italy (613 ± 623), the US (629 ± 386), and Japan (625 [302, 1047]), and milder phenotypes with less multisystem involvement. CONCLUSION The Chinese Han DM1 patients presented milder phenotypes compared to their Caucasian and Japanese counterparts. A male predominance and an early age of onset were identified in male Chinese Han DM1 patients.
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Affiliation(s)
- Huahua Zhong
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Li Zeng
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Xuefan Yu
- Department of Neurology and Neuroscience Center, The First Affiliated Hospital of Jilin University, Jilin, China
| | - Qing Ke
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yan Chen
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Lijun Luo
- Department of Neurology, Wuhan No.1 Hospital, Huazhong University of Science and Technology, Hubei, China
| | - Xueli Chang
- Department of Neurology, The First Hospital of Shanxi Medical University, Shanxi, China
| | - Junhong Guo
- Department of Neurology, The First Hospital of Shanxi Medical University, Shanxi, China
| | - Yiqi Wang
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Zhejiang, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Rongrong Liu
- Department of Neurology, Shaoxing Second Hospital, Zhejiang, China
| | - Changxia Liu
- Department of Neurology, Yancheng First People's Hospital, Jiangsu, China
| | - Jibao Wu
- Department of Neurology, Chenzhou First People's Hospital, Hunan, China
| | - Jie Lin
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Jianying Xi
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Wenhua Zhu
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Song Tan
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Fuchen Liu
- Department of Neurology, Qilu Hospital, Shandong University, Shangdong, China
| | - Jiahong Lu
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China.
| | - Sushan Luo
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China.
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Yue D, Jiao K, Xia X, Zhang J, Zhu B, Liu L, Du K, Gao M, Cheng N, Wang N, Luo S, Xi J, Lu J, Zhao C, Zhu W. Diagnostic delay in late-onset Pompe disease among Chinese patients: A retrospective study. JIMD Rep 2024; 65:39-46. [PMID: 38186848 PMCID: PMC10764198 DOI: 10.1002/jmd2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Surveys and retrospective studies have revealed considerable delays in diagnosing late-onset Pompe disease (LOPD) in China, where the contributing factors remain poorly represented. Our study analyzed the diagnostic journey of 34 LOPD patients seen at our neuromuscular clinic from 2005 to 2022. We defined diagnostic delay as the time from the onset of the first relevant symptoms and laboratory findings suggestive of LOPD to the eventual diagnosis, and we constructed a correlation matrix to assess relationships among these variables. The cohort consisted of 34 patients with an equal male-to-female ratio, and the mean age at diagnosis was 27.68 ± 10.03 years. We found the median diagnostic delay to be 5 years, with a range of 0.3 to 20 years, with 97.1% having been misdiagnosed previously, most commonly with "Type II Respiratory insufficiency" (36.7%). Notably, patients at earlier onset (mean age, 18.19 years vs. 31 years; p < 0.005) tended to have higher creatine kinase (CK) levels. Furthermore, 92.6% reported difficulty in sitting up from a supine position since childhood. Our research emphasizes the role of early indicators like dyspnea and difficulty performing sit-ups in adolescents for timely LOPD diagnosis and treatment initiation. The importance of early high-risk screening using dried blood spot testing cannot be overstated.
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Affiliation(s)
- Dongyue Yue
- Department of NeurologyJing'an District Center Hospital of ShanghaiShanghaiChina
| | - Kexin Jiao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Xingyu Xia
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jialong Zhang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Bochen Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Lingchun Liu
- The First People's Hospital of Yunnan ProvinceYunnanChina
| | - Kunzhao Du
- Jinshan Hospital Center for Neurosurgery, Jinshan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Mingshi Gao
- Department of PathologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Nachuan Cheng
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Ningning Wang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Sushan Luo
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jianying Xi
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jiahong Lu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Chongbo Zhao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Wenhua Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
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