Aspectos clínicos e nutricionais da doença de Gaucher: estudo prospectivo de 13 crianças em um único centro

Abstract

Gaucher disease is an autosomal recessive lysosomal storage disease, caused by mutation to the GBA gene (glucocerebrosidase gene) located on chromosome 1. The objective of the present study was to identify the clinical, nutritional, biochemical and genetic features of the patients with Gaucher disease treated at the Unit of Pediatric Hematology (Hospital das Clínicas-Universidade Federal de Minas Gerais). Thirteen patients were prospectively followed up. Gaucher disease was confirmed in all patients through the use of an enzyme assay test to measure glucocerebrosidase enzyme activity. Demographic and nutritional data, and biochemical findings obtained on admission, were studied. Genetic testing was performed in seven patients. The median age of follow-up was 5.3 years. Z scores for weight and height on admission and at the end of observation period were calculated. The standardized prevalence for malnutrition was calculated using the Mora method. The mean age at diagnosis was 5.8 years. The predominant clinical manifestations at diagnosis were hepatomegaly and splenomegaly, and all patients were classified as clinical type 1. Low platelet count and anemia were detected at diagnosis in eight and six children, respectively. The most frequent genetic mutation was N370S. One child died during follow-up due to septicemia, after splenectomy. The prevalence of malnutrition was 26% at admission and 48% at the end of the observation period. The analysis of data demonstrates that N370S and clinical type 1 predominate in our Unit, characterizing the milder form of the disease. The irregular enzyme replacement therapy during the study period did not allow valid clinical conclusions on its efficacy.