Nurmonen Heidi J, Huttunen Terhi, Huttunen Jukka, Kurtelius Arttu, Kotikoski Satu, Junkkari Antti, Koivisto Timo, von Und Zu Fraunberg Mikael, Kämäräinen Olli-Pekka, Lång Maarit, Isoniemi Helena, Jääskeläinen Juha E, Lindgren Antti E
1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio.
2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio.
J Neurosurg. 2020 Jul 3;134(6):1871-1878. doi: 10.3171/2020.4.JNS20544. Print 2021 Jun 1.
The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH).
The outcomes of 32 ADPKD patients with aSAH between 1980 and 2015 (median age 43 years; 50% women) were compared with 160 matched (age, sex, and year of aSAH) non-ADPKD aSAH patients in the prospectively collected Kuopio Intracranial Aneurysm Patient and Family Database.
At 12 months, 75% of the aSAH patients with ADPKD versus 71% of the matched-control aSAH patients without ADPKD had good outcomes (Glasgow Outcome Scale score 4 or 5). There was no significant difference in condition at admission. Hypertension had been diagnosed before aSAH in 69% of the ADPKD patients versus 27% of controls (p < 0.001). Multiple IAs were present in 44% of patients in the ADPKD group versus 25% in the control group (p = 0.03). The most common sites of ruptured IAs were the anterior communicating artery (47% vs 29%, p = 0.05) and the middle cerebral artery bifurcation (28% vs 31%), and the median size was 6.0 mm versus 8.0 mm (p = 0.02). During the median follow-up of 11 years, a second aSAH occurred in 3 of 29 (10%) ADPKD patients and in 4 of 131 (3%) controls (p = 0.11). A fatal second aSAH due to a confirmed de novo aneurysm occurred in 2 (6%) of the ADPKD patients but in none of the controls (p = 0.027).
The outcomes of ADPKD patients with aSAH did not differ significantly from those of matched non-ADPKD aSAH patients. ADPKD patients had an increased risk of second aSAH from a de novo aneurysm, warranting long-term angiographic follow-up.
作者旨在研究常染色体显性多囊肾病（ADPKD）这一已确定的颅内动脉瘤（IA）危险因素是否会影响动脉瘤性蛛网膜下腔出血（aSAH）的急性病程和长期预后。
将1980年至2015年间32例患有aSAH的ADPKD患者（中位年龄43岁；50%为女性）与前瞻性收集的库奥皮奥颅内动脉瘤患者及家系数据库中160例匹配（年龄、性别和aSAH年份）的非ADPKD的aSAH患者进行比较。
在12个月时，75%的患有ADPKD的aSAH患者与71%的匹配对照的非ADPKD的aSAH患者预后良好（格拉斯哥预后量表评分为4或5）。入院时病情无显著差异。69%的ADPKD患者在aSAH之前被诊断患有高血压，而对照组为27%（p<0.001）。ADPKD组44%的患者存在多发IA，而对照组为25%（p = 0.03）。破裂IA最常见的部位是前交通动脉（47%对29%，p = 0.05）和大脑中动脉分叉处（28%对31%），中位大小为6.0mm对8.0mm（p = 0.02）。在中位随访11年期间，29例ADPKD患者中有3例（10%）发生了第二次aSAH，131例对照中有4例（3%）发生了第二次aSAH（p = 0.11）。2例（6%）ADPKD患者因确诊的新发动脉瘤发生了致命的第二次aSAH，但对照组无此情况（p = 0.027）。
患有aSAH的ADPKD患者的预后与匹配的非ADPKD的aSAH患者无显著差异。ADPKD患者因新发动脉瘤发生第二次aSAH的风险增加，需要进行长期血管造影随访。
