Yoshida Hiroki, Higashihara Eiji, Maruyama Keisuke, Nutahara Kikuo, Nitatori Toshiaki, Miyazaki Isao, Shiokawa Yoshiaki
Department of Neurosurgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-City, Tokyo, 181-8611, Japan.
Department of Polycystic Kidney Research, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-City, Tokyo, 181-8611, Japan.
Acta Neurochir (Wien). 2017 Dec;159(12):2325-2330. doi: 10.1007/s00701-017-3316-8. Epub 2017 Sep 7.
Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease characterized by the progressive enlargement of innumerable renal cysts. Although the association of intracranial aneurysms (ICANs) with ADPKD is well known, the relationship between the ICAN and the disease severity including total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) is poorly understood.
We screened 265 patients with ADPKD (mean age, 48.8 years; range, 14.9-88.3 years) with MR angiography. The patients with a past history related to ICANs were excluded from the study. The incidence and characteristics of ICAN in patients with ADPKD were evaluated. TKV was measured by volumetric analyses of MR imaging.
We detected 65 ICANs in 49 patients (37 women and 12 men, mean age, 52.7 years; range, 20.4-86 years). The incidence of ICANs was 18.5% and female patients had was higher incidence (23.1%) than male patients (11.4%) (p = 0.02). An age of those with ICANs was significantly higher than those without (p = 0.006), and the cumulative risk of diagnosis of ICANs increased with age. TKV was significantly larger in those with ICANs than those without (p = 0.001), but eGFR was not different between two groups (p = 0.07). By multivariate analyses, only TKV was significantly related to the development of ICANs (p = 0.02).
The incidence of ICANs increased with age, was higher in females, and correlated with kidney enlargement in patients with ADPKD. Necessity of screening ICANs would be particularly high in elderly women with large kidneys.
常染色体显性多囊肾病（ADPKD）是一种遗传性肾病，其特征是无数肾囊肿逐渐增大。虽然颅内动脉瘤（ICANs）与ADPKD的关联已为人所知，但ICAN与疾病严重程度（包括总肾体积（TKV）和估计肾小球滤过率（eGFR））之间的关系却知之甚少。
我们对265例ADPKD患者（平均年龄48.8岁；范围14.9 - 88.3岁）进行了磁共振血管造影筛查。有ICANs既往史的患者被排除在研究之外。评估了ADPKD患者中ICAN的发生率和特征。通过磁共振成像的容积分析测量TKV。
我们在49例患者（37名女性和12名男性，平均年龄52.7岁；范围20.4 - 86岁）中检测到65个ICANs。ICANs的发生率为18.5%，女性患者的发生率（23.1%）高于男性患者（11.4%）（p = 0.02）。有ICANs的患者年龄显著高于无ICANs的患者（p = 0.006），且ICANs的诊断累积风险随年龄增加。有ICANs的患者TKV显著大于无ICANs的患者（p = 0.001），但两组间eGFR无差异（p = 0.07）。通过多变量分析，只有TKV与ICANs的发生显著相关（p = 0.02）。
ICANs的发生率随年龄增加，女性更高，且与ADPKD患者的肾脏增大相关。对于肾脏较大的老年女性，筛查ICANs的必要性尤其高。
