Journal of The Korean Society of Inherited Metabolic disease (대한유전성대사질환학회지)

The Korea Society of Inherited Metabolic Disease (대한유전성대사질환학회)
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The Clinical and Genetic Characteristics of Three Korean Patients with Glycogen Storage Disease Type V (McArdle Disease)

세 명의 대한민국 제 V형 당원축적근육병(McArdle 병) 환자들의 유전학적 및 임상적 특성 보고

  • Lee, Sunghee (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Kang, Eungu (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Kim, Yoonmyung (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Beom Hee (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Kim, Gu Hwan (Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Yoo, Han Wook (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine)
  • 이성희 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 강은구 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김윤명 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 이범희 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김구환 (울산대학교 의과대학 서울아산병원 의학유전학센터) ;
  • 유한욱 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Published : 2016.08.31
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Abstract

Purpose: McArdle disease, glycogen storage disease type V (GSD V), is one of the most common adolescent-onset glycogen storage diseases. It is caused by recessive mutations in PYGM encoding myophosphorylase, which is critical to glycogen metabolism. Since only a few korean patients have been reported, we will observe the clinical and genetic features of three korean patients with McArdle disease. Methods: We retrospectively reviewed the medical records of three patients with genetically confirmed McArdle disease, including the results of forearm ischemic exercise test, electromyogram, nerve conduction velocity, muscle biopsy, and PYGM analysis in peripheral leukocytes. Results: All three cases were males and their age of symptom onset was 12, 5, 14 years old, respectively. A high basal level of serum creatine kinase was noted in all three patients. They experienced the recurrent episodes of rhabdomyolysis, but second wind phenomenon was not definite. In muscle biopsy, subsarcolemmal space vacuoles including periodic acid schiff stained materials were found in two patients, while no evidence of glycogen storage disease was found in the other. A total of five different mutations, $p.Arg50^*$, p.Trp798Arg, $p.Arg50^*$, p.Glu779del, $p.Asp511Thrfs^*28$ and p.Phe710del, were found in three patients. Avoidance of isometric exercise, aerobic exercise and glucose intake before each exercise were recommended for all patients. Conclusion: The three Korean patients with McArdle disease showed the typical manifestations of the condition. The most mutations were private. Therefore, identification of more cases with long-term follow-up will be required to understand the clinical and genetic features of this disease among Korean population.

목적: McArdle 병은 당원분해의 주요 속도 조절 단계인 당원인산화의 장애로 운동 초기에 적절한 에너지 공급이 이루어지지 않아 운동내성 및 근력약화가 발생하는 상염색체 열성 근육병으로, 저자의 관점 하에 현재까지 보고된 대한민국 McArdle 병은 4례로, 본 논문은 대한민국 McArdle 병 환자를 추가 보고하고 이들의 임상증상 및 유전학적 변이를 밝히고자 한다. 방법: 2006년부터 2011년까지 임상증상과 일반 혈액 및 생화학 검사, 그리고 PYGM 유전자 검사로 확진된 총 3명의 McArdle 병 환자의 전자 차트를 후향적으로 검토하여, 검사 소견, 시행된 운동요법과 약물치료, 그리고 예후를 확인하였다. 돌연변이 분석은 말초 혈액에서 분리한 DNA에서 genomic DNA를 분리하고, primer를이용해PYGM의 20개 exon과 intronic flanking 배열을 증폭한 후 전기영동으로 DNA 염기서열을 분석하였다. 결과: 세 증례의 증상 발생 평균 연령은 $10.33{\pm}4.73$ 세로, 공통적으로 심한 근육통, 근육부종을 동반한 잦은 횡문근융해증, 높은 기저 혈청 크레아틴키나아제과 마이오글로빈 농도, 뚜렷하지 않은 second wind phenomenon을 보였다. 근육생검 결과, 증례 1은 정상소견을 보였으나, 증례 2는 subsarcolemmal 공간 내 당원침착과 적색열의 퇴행 및 괴사, 증례 3은 periodic acid Schiff stain에 염색되는 물질을 갖는 공포와 내핵을 포함한 근섬유 소견을 보여 당원축적증에 합당한 양상을 보였다. 결론: PYGM 염기서열 분석 결과에서는 증례 1에서 $p.Arg50^*$;p.Trp798Arg, 증례 2에서 $p.Arg50^*$;p.Glu779 del, 증례 3에서 $p.Asp511Thrfs^*28$;p.Phe710 del 복합 이형 접합자 돌연변이를 보였다.

Keywords

References

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