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肝豆状核变性,又名 Wilson 病(Wilson's disease,WD),是常染色体隐性遗传的慢性铜代谢障碍性疾病。早期Scheinberg和Sternlieb基于有限的数据估计该病的临床发病率为1/30000。随着肝豆状核变性患者的大量发现和基因测序手段的普及,科研人员对该病的发病率有了更深刻的认识。基于四项高质量的临床研究,Sandahl, T. D.等评估该病的发病率在1/29000至1/40000之间,而基于出生人口中WD患者的数量评估的发病率为1/40000至1/50000之间 (1)。
Table 1 根据出生人口评估的肝豆状核变性临床发病率
国家 |
日期 |
诊断病例 |
出生人口 |
发病率 |
参考文献 |
瑞士 |
1946-55 |
19 |
/ |
1:44800 |
(2) |
东德 |
1949-1977 |
123 |
4.2 mio/28年 |
1:34400 |
(3) |
西德 |
1962 |
/ |
/ |
1:86000 |
(4) |
撒丁岛 |
1971-1981 |
16 |
266944 |
1:16700 |
(5) |
爱尔兰 |
1980-1989 |
12 |
637 |
1:53000 |
(6) |
丹麦 |
1981-1985 |
4 |
55000/年 |
1:68750 |
(7) |
丹麦 |
1990-2009 |
28 |
70000/年 |
1:49500 |
(8) |
捷克共和国 |
1995-2008 |
76 |
95000/年 |
1:16500 |
(9) |
波兰 |
1996-2016 |
156 |
385000/年 |
1:49000 |
(10) |
Table 2 通过铜蓝蛋白和K-F环检测评估肝豆状核变性的临床发病率
方法/时间 |
国家 |
检测总量 |
WD患者数量 |
发病率 |
参考文献 |
血铜蓝蛋白 |
|||||
1999 |
日本 |
126810 |
0 |
0 |
(11) |
1999 |
日本 |
24165 |
3 |
1:8084 |
(11) |
1999 |
日本 |
2789 |
2 |
1:1400 |
(12) |
2002 |
韩国 |
3667 |
1 |
1:3667 |
(13) |
2006 |
美国 |
1398 |
0 |
0 |
(14) |
尿全铜蓝蛋白 |
|||||
2002 |
日本 |
48819 |
2 |
1:24400 |
(15) |
尿铜蓝蛋白 |
|||||
2008 |
日本 |
11362 |
1 |
1:11362 |
(16) |
K-F环 |
|||||
2014 |
中国 |
153370 |
9 |
1:17000 |
(17) |
参考文献
1. Sandahl TD, Laursen TL, Munk DE, Vilstrup H, Weiss KH, Ott P. The Prevalence of Wilson's Disease: An Update. Hepatology. 2020;71(2):722-32.
2. Tschumi A, Colombo JP, Moser H. [Wilson's disease in Switzerland. Clinical, genetic and biochemical studies]. Schweiz Med Wochenschr 1973;103:140-145 concl.
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7. Almdal TP, Sorensen TI. Incidence of parenchymal liver diseases in Denmark, 1981 to 1985: analysis of hospitalization registry data. The Danish Association for the Study of the Liver. Hepatology 1991;13:650-655.
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15. Owada M, Suzuki K, Fukushi M, Yamauchi K, Kitagawa T. Mass screening for Wilson's disease by measuring urinary holoceruloplasmin. J Pediatr 2002;140:614-616.
16. Nakayama K, Kubota M, Katoh Y, Sawada Y, Saito A, Nishimura K, Katsura E, et al. Early and presymptomatic detection of Wilson's disease at the mandatory 3-year-old medical health care examination in Hokkaido Prefecture with the use of a novel automated urinary ceruloplasmin assay. Mol Genet Metab 2008;94:363-367.
17. Cheng N, Wang K, Hu W, Sun D, Wang X, Hu J, Yang R, et al. Wilson disease in the South Chinese han population. Can J Neurol Sci 2014;41:363-367.