BACKGROUND:Women with 21-hydroxylase deficiency present much variability in external genitalia virilization, even among those with similar impairments of 21-hydroxylase (21OH) activity. OBJECTIVE:To evaluate if the number of CAG (nCAG) repeats of the androgen receptor gene influences the degree of external genitalia virilization in women with CYP21A2 mutations, grouped according to impairment of 21OH activity. PATIENTS:The nCAG was determined in 106 congenital adrenal hyperplasia (CAH) patients and in 302 controls. The patients were divided, according to their CYP21A2 genotypes, into Groups A and B, which confer total and severe impairment of 21OH activity, respectively. METHODS:The inactivation pattern of the X-chromosome was studied through genomic DNA digestion with Hpa II. The CAG repeat region was amplified by polymerase chain reaction (PCR) and analysed by GeneScan. RESULTS:The nCAG and the frequency of severe skewed X-inactivation did not differ between normal women and patients. The nCAG median in genotype A was 20.7 (IQR 2.3) for Prader I + II, 22.5 (3.6) for Prader III and 21 (2.9) for Prader IV + V (P < 0.05 for Prader III and Prader IV + V). The nCAG median in genotype B was 21.3 (1.1) for Prader I + II, 20.5 (2.9) for Prader III and 22 (2.8) for Prader IV + V (P > 0.05). A significant difference was found regarding the nCAG median in patients presenting Prader III from genotypes A and B. CONCLUSIONS:We observed great variability in the degree of external genitalia virilization in both CYP21A2 genotypes, and we showed that the CAG repeats of the androgen receptor gene influences this phenotypic variability.

译文

背景:缺乏21-羟化酶的女性在外生殖器生殖方面表现出很大的变异性,即使是那些具有类似21-羟化酶(21OH)活性受损的女性。
目的:评估CYP21A2突变女性中雄激素受体基因的CAG(nCAG)重复数是否影响其外生殖器病毒化程度,并根据21OH活性受损进行分组。
患者:nCAG是在106名先天性肾上腺皮质增生(CAH)患者和302名对照中确定的。根据他们的CYP21A2基因型将患者分为A组和B组,分别导致21OH活性的全面和严重损害。
方法:通过Hpa II基因组DNA消化研究X染色体的失活模式。 CAG重复区通过聚合酶链反应(PCR)进行扩增,并通过GeneScan分析。
结果:正常女性和患者的nCAG和严重偏斜的X-失活的频率没有差异。基因型A的nCAG中位数对于Prader I II是20.7(IQR 2.3),对于Prader III是22.5(3.6),对于Prader IV V是21(2.9)(对于Prader III和Prader IV V,P <0.05)。基因型B的nCAG中位数对于Prader I II是21.3(1.1),对于Prader III是20.5(2.9),对于Prader IV V是22(2.8)(P> 0.05)。发现来自基因型A和B的Prader III患者的nCAG中位数存在显着差异。
结论:我们在两种CYP21A2基因型中观察到外部生殖器病毒化程度的巨大差异,并且我们表明雄激素受体基因的CAG重复影响了该表型变异性。

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