Zhou Zien, Xu Ying, Delcourt Candice, Shan Jiehui, Li Qiang, Xu Jianrong, Hackett Maree L
Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Cerebrovasc Dis. 2017;44(1-2):75-82. doi: 10.1159/000476073. Epub 2017 May 13.
The prevalence of intracranial aneurysm in patients with autosomal dominant polycystic kidney disease (ADPKD) is higher than that among the general population. We performed a systematic review and meta-analysis on the prevalence and natural history of intracranial aneurysm among patients with ADPKD.
Medline, Embase, Web of Science and Scopus, from inception to July 2016, were searched for studies reporting the occurrence of intracranial aneurysms among participants with ADPKD. Two authors independently assessed the eligibility of all retrieved studies and extracted data. Information on the prevalence of intracranial aneurysms and their natural history in participants with ADPKD was collected from all included studies.
Fifteen studies with 1,490 participants with ADPKD were pooled to study about the prevalence of intracranial aneurysm in participants with ADPKD, and the prevalence rate was found to be 10% (95% CI 7-13%). Studies from China, Japan and Europe (Germany, Poland) reported a higher prevalence of intracranial aneurysm. Having a family history of haemorrhagic stroke or intracranial aneurysm was a risk factor for aneurysm occurrence. Twenty-three percent (95% CI 15-31%) of the participants had multiple aneurysms. Most of the aneurysms were small (<6 mm) and located in the anterior circulation. Five studies with 171 participants (83 with 106 aneurysms at baseline and 88 without) were analyzed to understand the natural history of aneurysms, with an incidence of aneurysm growth, new aneurysm and aneurysm rupture of 1.84% (followed up for 435 person-years), 0.57% (1,227 person-years) and 0.13% (792 person-years) respectively.
Screening for intracranial aneurysm is recommended in patients with ADPKD when there is a family history of haemorrhagic stroke or intracranial aneurysm and when they are from China, Japan or Europe (Germany, Poland). Based on existing data, regular imaging follow-up is not supported. High-quality, prospective studies are needed in the future.
常染色体显性多囊肾病（ADPKD）患者颅内动脉瘤的患病率高于普通人群。我们对ADPKD患者颅内动脉瘤的患病率及自然病史进行了系统评价和荟萃分析。
检索Medline、Embase、Web of Science和Scopus数据库，检索时间从建库至2016年7月，查找报告ADPKD参与者颅内动脉瘤发生情况的研究。两名作者独立评估所有检索到的研究的合格性并提取数据。从所有纳入研究中收集ADPKD参与者颅内动脉瘤患病率及其自然病史的信息。
汇总了15项研究，共1490例ADPKD参与者，以研究ADPKD参与者颅内动脉瘤的患病率，发现患病率为10%（95%CI 7-13%）。来自中国、日本和欧洲（德国、波兰）的研究报告的颅内动脉瘤患病率较高。有出血性中风或颅内动脉瘤家族史是动脉瘤发生的危险因素。23%（95%CI 15-31%）的参与者有多个动脉瘤。大多数动脉瘤较小（<6mm），位于前循环。分析了5项研究，共171例参与者（83例基线时有106个动脉瘤，88例无动脉瘤），以了解动脉瘤的自然病史，动脉瘤生长、新发动脉瘤和动脉瘤破裂的发生率分别为1.84%（随访435人年）、0.57%（1227人年）和0.13%（792人年）。
对于有出血性中风或颅内动脉瘤家族史的ADPKD患者，以及来自中国、日本或欧洲（德国、波兰）的患者，建议进行颅内动脉瘤筛查。基于现有数据，不支持定期影像学随访。未来需要高质量的前瞻性研究。
