Mishima Eikan, Umezawa Shu, Suzuki Takehiro, Fujimura Miki, Abe Michiaki, Hashimoto Junichiro, Abe Takaaki, Ito Sadayoshi
Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan.
Clin Exp Nephrol. 2018 Dec;22(6):1294-1299. doi: 10.1007/s10157-018-1575-1. Epub 2018 Apr 20.
Fibromuscular dysplasia (FMD), which usually affects the renal artery, also affects the carotid, vertebral, and intracranial arteries. Previous studies have shown a high prevalence of concomitant renal artery and cervicocranial lesions in FMD patients. However, the analyzed subjects were mostly Caucasians in Western countries.
We performed a retrospective analysis to examine the prevalence of cervicocranial vascular lesions in Japanese FMD patients with renal artery involvement at a single institution. The presence of cervicocranial lesions was evaluated by Doppler echography and magnetic resonance angiography. We compared this prevalence with that reported in the literature.
Thirty-one Japanese FMD patients with renal artery lesions were studied. The mean age was 30 ± 12 years, 71% were women, and 16% were smokers; all patients were Asians and had hypertension. Multifocal, tubular, and unifocal types of renal lesions were found in 52, 35, and 13% of patients, respectively. Bilateral renal lesions were found in 13% of patients. None of the patients had a cervical vascular lesion associated with FMD. Only two patients (8%) had a lesion in the intracranial artery, of which one was a known case of moyamoya disease.
These findings suggest that cervical artery involvement and intracranial artery involvement are not common in renal FMD patients in Japan, which is in contrast to the data reported for Caucasian patients in Western countries. Ethnic differences could influence the occurrence of cervicocranial lesions. A study with a larger sample size should be performed to validate these findings.
纤维肌性发育不良(FMD)通常累及肾动脉,也可累及颈动脉、椎动脉和颅内动脉。既往研究显示,FMD患者中肾动脉和颈颅病变同时存在的情况很常见。然而,分析的对象大多是西方国家的白种人。
我们进行了一项回顾性分析,以研究在一家机构中肾动脉受累的日本FMD患者颈颅血管病变患病率。通过多普勒超声和磁共振血管造影评估颈颅病变的存在情况。我们将该患病率与文献报道的患病率进行了比较。
对31例有肾动脉病变的日本FMD患者进行了研究。平均年龄为30±12岁,71%为女性,16%为吸烟者;所有患者均为亚洲人且患有高血压。分别在52%、35%和13%的患者中发现多灶性、管状和单灶性肾病变类型。13%的患者存在双侧肾病变。没有患者有与FMD相关的颈部血管病变。只有两名患者(8%)颅内动脉有病变,其中一例是已知的烟雾病病例。
这些发现表明,在日本,肾FMD患者中颈动脉受累和颅内动脉受累并不常见,这与西方国家白种人患者的数据相反。种族差异可能影响颈颅病变的发生。应进行更大样本量的研究以验证这些发现。