School of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
J Clin Neurosci. 2019 Nov;69:220-223. doi: 10.1016/j.jocn.2019.07.048. Epub 2019 Jul 29.
Approximately 8% of patients with autosomal dominant polycystic kidney disease (ADPKD) develop intracranial aneurysms. The reason for development of intracranial aneurysms in ADPKD patients might be related to interactions between the presence of hypertension and the basic mechanism underlying the disease, which leads to weakness of the connective tissue. In this study, we aimed to identify differences in aneurysm morphology between ADPKD patients and a location-matched set of controls.
A total of 42 ADPKD patients and 49 control patients with 122 aneurysms were included. Aneurysm size, location, and morphology were evaluated by two neuroradiologists. Aneurysm morphology was classified into one of three groups: regular saccular, irregular saccular, and fusiform. Continuous variables were compared with chi-squared tests and categorical variables were compared with student's t-test.
When considering all patients, there was no significant difference in aneurysm morphology or size (4.5 ± 2.6 mm vs 5.4 ± 2.9 mm; p = 0.09) between the ADPKD and control group. In a subgroup analysis of medium and large aneurysms (n = 61), there was a significantly lower incidence of regular saccular aneurysms (28% vs. 56%; p = 0.03) and higher incidence of fusiform aneurysms (12% vs 0%; p = 0.03) in the ADPKD group compared to a control group.
When excluding categorically "small" aneurysms, there is a reduced incidence of regular saccular aneurysms and increased incidence of fusiform aneurysms in ADPKD patients compared to a control group. Further study of this population of patients is warranted to better understand their risks of aneurysm rupture and indications for treatment.
大约 8%的常染色体显性多囊肾病（ADPKD）患者会发生颅内动脉瘤。ADPKD 患者发生颅内动脉瘤的原因可能与高血压的存在以及导致结缔组织薄弱的疾病基本机制之间的相互作用有关。在这项研究中，我们旨在确定 ADPKD 患者与位置匹配的对照组之间动脉瘤形态的差异。
共纳入 42 名 ADPKD 患者和 49 名对照组患者，共 122 个动脉瘤。由两名神经放射科医生评估动脉瘤的大小、位置和形态。将动脉瘤形态分为规则囊状、不规则囊状和梭形三种类型之一。连续变量用卡方检验进行比较，分类变量用学生 t 检验进行比较。
当考虑所有患者时，ADPKD 组和对照组在动脉瘤形态或大小方面没有显著差异（4.5±2.6mm 与 5.4±2.9mm；p=0.09）。在中大型动脉瘤的亚组分析中（n=61），ADPKD 组规则囊状动脉瘤的发生率明显较低（28%与 56%；p=0.03），梭形动脉瘤的发生率较高（12%与 0%；p=0.03）。
排除明确的“小”动脉瘤后，与对照组相比，ADPKD 患者的规则囊状动脉瘤发生率降低，梭形动脉瘤发生率升高。需要对这一患者群体进行进一步研究，以更好地了解他们的动脉瘤破裂风险和治疗指征。
