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Background:Mitochondrial diseases are a group otenergy metabolic disorders with multisystem involvements.Variable clinical features present a major challenge in pediatric diagnoses.We summarized the clinical spectrum of m.3243A＞G mutation in Chinese pediatric patients,to define the common clinical manifestations and study the correlation between heteroplasmic degree of the mutation and clinical severity of the disease.Methods:Clinical data of one-hundred pediatric patients with symptomatic mitochondrial disease harboring m.3243A＞G mutation from 2007 to 2013 were retrospectively reviewed.Detection of m.3243A＞G mutation ratio was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism.Correlation between m.3243A＞G mutation ratio and age was evaluated.The differences in clinical symptom frequency of patients with low,middle,and high levels of mutation ratio were analyzed by Chi-square test.Results:Sixty-six patients (66％) had suffered a delayed diagnosis for an average of 2 years.The most frequent symptoms were seizures (76％),short stature (73％),elevated plasma lactate (70％),abnormal magnetic resonance imaging/computed tomography (MRI/CT) changes (68％),vomiting (55％),decreased vision (52％),headache (50％),and muscle weakness (48％).The mutation ratio was correlated negatively with onset age (r =-0.470,P ＜ 0.001).Myopathy was more frequent in patients with a high level of mutation ratio.However,patients with a low or middle level of m.3243A＞G mutation ratio were more likely to suffer hearing loss,decreased vision,and gastrointestinal disturbance than patients with a high level of mutation ratio.Conclusions:Our study showed that half of Chinese pediatric patients with m.3243A＞G mutation presented seizures,short stature,abnormal MRI/CT changes,elevated plasma lactate,vomiting,and headache.Pediatric patients with these recurrent symptoms should be considered for screening m.3243A＞G mutation.Clinical manifestations and laboratory abnormalities should be carefully monitored in patients with this point mutation.