| 词条 | Gilbert's syndrome |
| 释义 |
| name = Gilbert's syndrome | synonyms = Meulengracht syndrome, Gilbert-Lereboullet syndrome, hyperbilirubinemia Arias type, hyperbilirubinemia type 1, familial cholemia, familial nonhemolytic jaundice[1][2] | image = Bilirubin.svg | caption = Bilirubin | pronounce = {{IPAc-en|ʒ|iː|l|ˈ|b|ɛər|z}} {{respell|zheel|BAIRZ}} | speciality = Gastroenterology | symptoms = None, slight jaundice[1] | complications = Usually none[1] | onset = | duration = | types = | causes = Genetic[1] | risks = | diagnosis = | differential = Crigler-Najjar syndrome, Rotor syndrome, Dubin-Johnson syndrome[2] | prevention = | treatment = None typically needed[1] | medication = | prognosis = | frequency = ~5%[8] | deaths = }}Gilbert's syndrome (GS) is a mild liver disorder in which the liver does not properly process bilirubin.[1] Many people never have symptoms.[1] Occasionally a slight yellowish color of the skin or whites of the eyes may occur.[1] Other possible symptoms include feeling tired, weakness, and abdominal pain.[1] Gilbert's syndrome is due to a mutation in the UGT1A1 gene which results in decreased activity of the bilirubin uridine diphosphate glucuronosyltransferase enzyme.[1][8] It is typically inherited in an autosomal recessive pattern and occasionally in an autosomal dominant pattern depending on the type of mutation.[8] Episodes of jaundice may be triggered by stress such as exercise, menstruation, or not eating.[2] Diagnosis is based on higher levels of unconjugated bilirubin in the blood without either signs of other liver problems or red blood cell breakdown.[3][2] Typically no treatment is needed.[1] If jaundice is significant phenobarbital may be used.[1] Gilbert's syndrome affects about 5% of people in the United States.[2] Males are more often diagnosed than females.[1] It is often not noticed until late childhood to early adulthood.[3] The condition was first described in 1901 by Augustin Nicolas Gilbert.[3][4] Signs and symptomsJaundiceGilbert's syndrome produces an elevated level of unconjugated bilirubin in the bloodstream, but normally has no serious consequences. Mild jaundice may appear under conditions of exertion, stress, fasting, and infections, but the condition is otherwise usually asymptomatic.[5][6] Severe cases are seen by yellowing of the skin tone and yellowing of the sclera in the eye. GS has been reported to possibly contribute to an accelerated onset of neonatal jaundice, especially in the presence of increased red blood cell destruction due to diseases such as G6PD deficiency.[7][8] This situation can be especially dangerous if not quickly treated, as the high bilirubin causes irreversible neurological disability in the form of kernicterus. Detoxification of certain drugsThe enzymes that are defective in GS - UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) - are also responsible for some of the liver's ability to detoxify certain drugs. For example, Gilbert's syndrome is associated with severe diarrhea and neutropenia in patients who are treated with irinotecan, which is metabolized by UGT1A1.[9] While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with GS.[11][12] A subset of people with GS may have an increased risk of paracetamol toxicity.[12][35] Cardiovascular effectsSeveral analyses have found a significantly decreased risk of coronary artery disease (CAD) in individuals with GS.[13][14] Specifically, people with mildly elevated levels of bilirubin (1.1 mg/dl to 2.7 mg/dl) were at lower risk for CAD and at lower risk for future heart disease.[15] These researchers went on to perform a meta-analysis of data available up to 2002, and confirmed the incidence of atherosclerotic disease (hardening of the arteries) in subjects with GS had a close and inverse relationship to the serum bilirubin.[13] This beneficial effect was attributed to bilirubin IXα which is recognized as a potent antioxidant, rather than confounding factors such as high-density lipoprotein levels.[15] This association was also seen in long-term data from the Framingham Heart Study.[16]{{primary source inline|date=September 2018}} Moderately elevated levels of bilirubin in people with GS and the (TA)7/(TA)7 genotype were associated with one-third the risk for both coronary heart disease and cardiovascular disease as compared to those with the (TA)6/(TA)6 genotype (i.e. a normal, nonmutated gene locus). Platelet counts and MPV are decreased in patients with Gilbert's Syndrome. The elevated levels of bilirubin and decreasing levels of MPV and CRP in Gilbert's syndrome patients may have an effect on the slowing down of the atherosclerotic process.{{citation needed|date=September 2018}} OtherSymptoms, whether connected or not to GS, have been reported in a subset of those affected: feeling tired all the time (fatigue), difficulty maintaining concentration, unusual patterns of anxiety, loss of appetite, nausea, abdominal pain, loss of weight, itching (with no rash), and others,[17] but scientific studies found no clear pattern of adverse symptoms related to the elevated levels of unconjugated bilirubin in adults. However, other substances glucuronidized by the affected enzymes in Gilbert's syndrome sufferers could theoretically, at their toxic levels, cause these symptoms.[18][19] Consequently, debate exists about whether GS should be classified as a disease.[18][20] However, Gilbert's syndrome has been linked to an increased risk of gallstones.[17][21] GeneticsGilbert's syndrome is a phenotypic effect, characterized by mild jaundice due to increased unconjugated bilirubin, that arises from several different genotypic variants of the gene for the enzyme responsible for changing bilirubin to the conjugated form.{{citation needed|date=December 2018}} Gilbert's syndrome is characterized by a 70–80% reduction in the glucuronidation activity of the enzyme, (UGT1A1). The UGT1A1 gene is located on human chromosome 2.[22] More than 100 variants of the UGT1A1 gene are known, designated as UGT1A1*n (where n is the general chronological order of discovery), either of the gene itself or of its promoter region. UGT1A1 is associated with a TATA box promoter region; this region most commonly contains the genetic sequence A(TA)6TAA; this variant accounts for about 50% of alleles in many populations. However, several allelic polymorphic variants of this region occur, the most common of which results from adding another dinucleotide repeat TA to the promoter region, resulting in A(TA)7TAA, which is called UGT1A1*28; this common variant accounts for about 40% of alleles in some populations, but is seen less often, around 3% of alleles, in Southeast and East Asian people and Pacific Islanders. In most populations, Gilbert's syndrome is most commonly associated with homozygous A(TA)7TAA alleles.[23][24][25] In 94% of GS cases, two other glucuronosyltransferase enzymes, UGT1A6 (rendered 50% inactive) and UGT1A7 (rendered 83% ineffective), are also affected. However, Gilbert's syndrome can arise without TATA box promoter polymorphic mutations; in some populations, particularly healthy Southeast and East Asians, Gilbert's syndrome is more often a consequence of heterozygote missense mutations (such as Gly71Arg also known as UGT1A1*6, Tyr486Asp also known as UGT1A1*7, Pro364Leu also known as UGT1A1*73) in the actual gene coding region,[26] which may be associated with significantly higher bilirubin levels.[26] Because of its effects on drug and bilirubin breakdown and because of its genetic inheritance, Gilbert's syndrome can be classed as a minor inborn error of metabolism. DiagnosisPeople with GS predominantly have elevated unconjugated bilirubin, while conjugated bilirubin is usually within the normal range and is less than 20% of the total. Levels of bilirubin in GS patients are reported to be from 20 μM to 90 μM (1.2 to 5.3 mg/dl)[24] compared to the normal amount of < 20 μM. GS patients have a ratio of unconjugated/conjugated (indirect/direct) bilirubin commensurately higher than those without GS. The level of total bilirubin is often further increased if the blood sample is taken after fasting for two days,[27] and a fast can, therefore, be useful diagnostically. A further conceptual step that is rarely necessary or appropriate is to give a low dose of phenobarbital:[28] the bilirubin will decrease substantially. Tests can also detect DNA mutations of UGT1A1 by polymerase chain reaction or DNA fragment sequencing. Differential diagnosisWhile Gilbert's syndrome is considered harmless, it is clinically important because it may give rise to a concern about a blood or liver condition, which could be more dangerous. However, these conditions have additional indicators:
TreatmentTypically no treatment is needed.[1] If jaundice is significant phenobarbital may be used.[1] HistoryGilbert's syndrome was first described by French gastroenterologist Augustin Nicolas Gilbert and co-workers in 1901.[4][29] In German literature, it is commonly associated with Jens Einar Meulengracht.[30] Alternative, less common names for this disorder include:
Notable cases
References1. ^1 2 3 4 5 6 7 8 9 10 11 12 13 14 {{cite web|title=Gilbert syndrome|url=https://rarediseases.info.nih.gov/diseases/6507/gilbert-syndrome|website=GARD|accessdate=2 July 2017|language=en|date=2016|deadurl=no|archiveurl=https://web.archive.org/web/20170804052908/https://rarediseases.info.nih.gov/diseases/6507/gilbert-syndrome|archivedate=4 August 2017|df=}} 2. ^1 2 3 4 5 {{cite web|title=Gilbert syndrome|url=https://ghr.nlm.nih.gov/condition/gilbert-syndrome|website=Genetics Home Reference|accessdate=2 July 2017|language=en|date=27 June 2017|deadurl=no|archiveurl=https://web.archive.org/web/20170627221429/https://ghr.nlm.nih.gov/condition/gilbert-syndrome|archivedate=27 June 2017|df=}} 3. ^1 2 3 4 {{cite web|title=Gilbert Syndrome|url=https://rarediseases.org/rare-diseases/gilbert-syndrome/|website=NORD (National Organization for Rare Disorders)|accessdate=2 July 2017|date=2015|deadurl=no|archiveurl=https://web.archive.org/web/20170220165114/https://rarediseases.org/rare-diseases/gilbert-syndrome/|archivedate=20 February 2017|df=}} 4. ^1 {{cite web|title=Whonamedit - dictionary of medical eponyms|url=http://www.whonamedit.com/synd.cfm/2877.html|website=www.whonamedit.com|accessdate=2 July 2017|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20160918015240/http://www.whonamedit.com/synd.cfm/2877.html|archivedate=18 September 2016|df=}} 5. ^Kasper et al., Harrison's Principles of Internal Medicine, 16th edition, McGraw-Hill 2005 6. ^Boon et al., Davidson's Principles & Practice of Medicine, 20th edition, Churchill Livingstone 2006 7. ^{{cite journal |vauthors=Bancroft JD, Kreamer B, Gourley GR |title=Gilbert syndrome accelerates development of neonatal jaundice |journal=Journal of Pediatrics | volume=132 |issue=4 |pages=656–60 |year=1998 |pmid=9580766 |doi=10.1016/S0022-3476(98)70356-7}} 8. ^{{cite journal |vauthors=Cappellini MD, Di Montemuros FM, Sampietro M, Tavazzi D, Fiorelli G |title=The interaction between Gilbert's syndrome and G6PD deficiency influences bilirubin levels |journal=British Journal of Haematology | volume=104 |issue=4 |pages=928–9 |year=1999 |pmid=10192462 |doi=10.1111/j.1365-2141.1999.1331a.x}} 9. ^{{cite journal |vauthors=Marcuello E, Altés A, Menoyo A, Del Rio E, Gómez-Pardo M, Baiget M | title=UGT1A1 gene variations and irinotecan treatment in patients with metastatic colorectal cancer | journal=Br J Cancer | volume=91 | issue=4 | pages=678–82 | year=2004 | pmid=15280927 | doi=10.1038/sj.bjc.6602042 | pmc=2364770}} 10. ^{{cite journal |vauthors=Rauchschwalbe S, Zuhlsdorf M, Wensing G, Kuhlmann J | title=Glucuronidation of acetaminophen is independent of UGT1A1 promotor genotype | journal=Int J Clin Pharmacol Ther | volume=42 | issue=2 | pages=73–7 | year=2004 | pmid=15180166 | doi=10.5414/cpp42073}} 11. ^{{cite journal |vauthors=Kohle C, Mohrle B, Munzel PA, Schwab M, Wernet D, Badary OA, Bock KW | title=Frequent co-occurrence of the TATA box mutation associated with Gilbert's syndrome (UGT1A1*28) with other polymorphisms of the UDP-glucuronosyltransferase-1 locus (UGT1A6*2 and UGT1A7*3) in Caucasians and Egyptians | journal=Biochem Pharmacol | volume=65 | issue=9 | pages=1521–7 | year=2003 | pmid=12732365 | doi=10.1016/S0006-2952(03)00074-1}} 12. ^1 {{cite journal |vauthors=Esteban A, Pérez-Mateo M |title=Heterogeneity of paracetamol metabolism in Gilbert's syndrome |journal=European Journal of Drug Metabolism and Pharmacokinetics |volume=24 |issue=1 |pages=9–13 |year=1999 |pmid=10412886 |doi=10.1007/BF03190005}} 13. ^1 {{cite journal |author1=Ladislav Novotnýc |author2=Libor Vítek |title=Inverse Relationship Between Serum Bilirubin and Atherosclerosis in Men: A Meta-Analysis of Published Studies |journal=Experimental Biology and Medicine |issue= 5|pages=568–571 |year=2003 |pmid=12709588 |volume=228 |doi=10.1177/15353702-0322805-29}} 14. ^{{cite journal |author1=Schwertner Harvey A |author2=Vítek Libor | title=Gilbert syndrome, UGT1A1*28 allele, and cardiovascular disease risk: possible protective effects and therapeutic applications of bilirubin | journal=Atherosclerosis |volume=198| issue=1 | pages=1–11 |date= May 2008|pmid=18343383 | doi=10.1016/j.atherosclerosis.2008.01.001|url=https://zenodo.org/record/1258770|type=Review }} 15. ^1 {{cite journal |author=Vítek L |title=Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels |journal=Atherosclerosis |volume=160 |issue=2 |pages=449–56 |year=2002|pmid=11849670 |doi=10.1016/S0021-9150(01)00601-3 |author2= Jirsa M |author3= Brodanová M |displayauthors=etal }} 16. ^{{cite journal | author=Lin JP | title=Association between the UGT1A1*28 allele, bilirubin levels, and coronary heart disease in the Framingham Heart Study | journal=Circulation | volume=114 | pages=1476–81 | year=2006 | pmid=17000907 | doi=10.1161/CIRCULATIONAHA.106.633206 | issue=14| author2= O’Donnell CJ | author3= Schwaiger JP | displayauthors=etal }} 17. ^1 GilbertsSyndrome.com {{webarchive|url=https://web.archive.org/web/20060810065536/http://www.gilbertssyndrome.com/ |date=2006-08-10 }} 18. ^1 {{cite journal |vauthors=Olsson R, Bliding A, Jagenburg R, Lapidus L, Larsson B, Svärdsudd K, Wittboldt S | title=Gilbert's syndrome—does it exist? A study of the prevalence of symptoms in Gilbert's syndrome | journal= Acta Med Scandinavia | volume=224 | issue=5 | pages=485–490 | year=1988 | pmid=3264448 | doi=10.1111/j.0954-6820.1988.tb19615.x}} 19. ^{{cite journal |vauthors=Bailey A, Robinson D, Dawson AM | title=Does Gilbert's disease exist? | journal=Lancet | volume=1 | pages=931–3 | year=1977 | pmid=67389 | doi=10.1016/S0140-6736(77)92226-7 | issue=8018}} 20. ^{{cite journal |author1=Larissa K. F. Temple |author2=Robin S. McLeod |author3=Steven Gallinger |author4=James G. Wright | title=Defining Disease in the Genomics Era | journal= Science Magazine | volume=293 | issue=5531 | pages=807–808 | year=2001 | doi=10.1126/science.1062938 | pmid=11486074}} 21. ^{{cite journal |vauthors=del Giudice EM, Perrotta S, Nobili B, Specchia C, d'Urzo G, Iolascon A |title=Coinheritance of Gilbert syndrome increases the risk for developing gallstones in patients with hereditary spherocytosis |journal=Blood |volume=94 |issue=7 |pages=2259–62 |date=October 1999 |pmid=10498597 |url=http://bloodjournal.hematologylibrary.org/cgi/pmidlookup?view=long&pmid=10498597}} 22. ^{{cite web|title=Entrez Gene: UGT1A1 UDP glucuronosyltransferase 1 family, polypeptide A1|url=https://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=54658|accessdate=|deadurl=no|archiveurl=https://web.archive.org/web/20101205081110/http://www.ncbi.nlm.nih.gov/sites/entrez?db=gene|archivedate=2010-12-05|df=}} 23. ^{{cite journal|vauthors=Raijmakers MT, Jansen PL, Steegers EA, Peters WH |title=Association of human liver bilirubin UDP-glucuronyltransferase activity, most commonly due to a polymorphism in the promoter region of the UGT1A1 gene|journal=Journal of Hepatology|year=2000|volume=33|issue=3|pages=348–351|pmid=11019988|doi=10.1016/S0168-8278(00)80268-8}} 24. ^1 {{cite journal | author=Bosma PJ | title=The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert's syndrome |journal=New England Journal of Medicine| volume=333 | issue=18 | pages=1171–5 | year=1995 | pmid=7565971 |doi=10.1056/NEJM199511023331802| author2= Chowdhury JR | author3= Bakker C | author4= Gantla S | author5= de Boer A | author6= Oostra BA | author7= Lindhout D | author8= Tytgat GN | author9= Jansen PL | author10= Oude Elferink RP | displayauthors=etal }} 25. ^{{cite journal |vauthors=Monaghan G, Ryan M, Seddon R, Hume R, Burchell B | title=Genetic variation in bilirubin UPD-glucuronosyltransferase gene promoter and Gilbert's syndrome | journal=Lancet | volume=347 | issue=9001 | pages=578–81 | year=1996 | pmid=8596320 | doi=10.1016/S0140-6736(96)91273-8}} 26. ^1 2 {{EMedicine|article|176822|Gilbert Syndrome}} 27. ^{{cite journal |author1=J L Gollan |author2=C Bateman |author3=B H Billing |title=Effect of dietary composition on the unconjugated hyperbilirubinaemia of Gilbert's syndrome |journal=Gut |issue= 5|pages=335–340 |year=1976 |doi=10.1136/gut.17.5.335 |volume=17 |pmid=1278716 |pmc=1411132}} 28. ^{{cite journal |author1=N Carulli |author2=M Ponz de Leon |author3=E Mauro |author4=F Manenti |author5=A Ferrari |title=Alteration of drug metabolism in Gilbert's syndrome |journal=Gut |issue= 8|pages=581–587 |year=1976 |doi=10.1136/gut.17.8.581 |volume=17 |pmid=976795 |pmc=1411334}} 29. ^{{cite journal |vauthors=Gilbert A, Lereboullet P |title=La cholemie simple familiale |journal=Sem Med |volume=21 |pages=241–3 |year=1901 }} 30. ^{{WhoNamedIt|doctor|2449|Jens Einar Meulengracht}} 31. ^{{cite journal |author1=Foulk, WT |author2=Butt, HR |author3=Owen, CA Jr |author4=Whitcomb, FF Jr |author5=Mason, HL | title=Constitutional hepatic dysfunction (Gilbert's disease): its natural history and related syndromes | journal=Medicine (Baltimore) | volume=38 | year=1959 | pmid=13632313 | pages=25–46 | issue=1|doi=10.1097/00005792-195902000-00002 }} 32. ^{{cite book|last=Shmaefsky|first=Brian|title=Biotechnology 101|publisher=Greenwood Publishing Group|year=2006|pages=175|chapter=5|isbn=978-0-313-33528-0|chapter-url=https://books.google.com/books?id=E4KhutqTYNAC&pg=PA175&lpg=PA175&dq=%22Arthur+Kornberg%22+gilbert&q=%22Arthur%20Kornberg%22%20gilbert|deadurl=no|archiveurl=https://web.archive.org/web/20171105195613/https://books.google.com/books?id=E4KhutqTYNAC&pg=PA175&lpg=PA175&dq=%22Arthur+Kornberg%22+gilbert&q=%22Arthur%20Kornberg%22%20gilbert|archivedate=2017-11-05|df=}} 33. ^{{cite news|title=Wire preaches delights of three cliffs|date=2007-04-27|work=South Wales Evening Post|pages=3}} 34. ^{{cite news |author=David Cox. |title=A Tennis Player Learns to Be Aggressive for Health’s Sake |newspaper=New York Times |date=19 April 2014 |url=https://www.nytimes.com/2014/04/20/sports/tennis/tennis-roundup.html |location=Monte Carlo |deadurl=no |archiveurl=https://web.archive.org/web/20161014010306/http://www.nytimes.com/2014/04/20/sports/tennis/tennis-roundup.html |archivedate=14 October 2016 |df= }} 35. ^{{cite web |url=https://www.autosport.com/motogp/news/132907/illness-that-hut-down-folger-diagnosed |title=Illness that 'shut down' Tech3 MotoGP rookie Jonas Folger diagnosed |last=Khorounzhiy |first=Valentin |date=2017-11-09 |website=Autosport.com |publisher=Motorsport Network |access-date=2017-11-09 |quote=After visiting specialists in his native Germany, Folger has been diagnosed with Gilbert's syndrome - a genetic ailment that precludes the liver from correctly processing bilirubin.}} External links{{Medical resources| DiseasesDB = 5218 | ICD10 = {{ICD10|E|80|4|e|70}} | ICD9 = {{ICD9|277.4}} | ICDO = | OMIM = 143500 | MedlinePlus = 000301 | eMedicineSubj = med | eMedicineTopic = 870 | MeshID = D005878 }}
6 : Accessory digestive gland disorders|Hepatology|Heme metabolism disorders|Genetic syndromes|Pediatrics|RTT |
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