Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO.
Department of Medicine, Jacobi Medical Center, New York, PA.
Ann Vasc Surg. 2021 Jul;74:450-459. doi: 10.1016/j.avsg.2021.01.075. Epub 2021 Feb 5.
BACKGROUND-OBJECTIVE: Prior studies have suggested a higher prevalence of simple renal cysts (SRC) among patients with aortic disease, including abdominal aortic aneurysms (AAA). Thus, the aim of this study was to systematically review all currently available literature and investigate whether patients with AAA are more likely to have SRC.
This study was performed according to the PRISMA guidelines. A meta-analysis was conducted with the use of random effects modeling and the I-square was used to assess heterogeneity. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were synthesized to compare the prevalence of several patients' characteristics between AAA vs. no-AAA cases.
Eleven retrospective studies, 9 comparative (AAA vs. no-AAA groups) and 3 single-arm (AAA group), were included in this meta-analysis, enrolling patients (AAA: N = 2,297 vs. no-AAA: N = 35,873) who underwent computed tomography angiography as part of screening or preoperative evaluation for reasons other than AAA. The cumulative incidence of SRC among patients with AAA and no-AAA was 55% (95% CI: 49%-61%) and 32% (95% CI: 22%-42%) respectively, with a statistically higher odds of SRC among patients with AAA (OR: 3.02; 95% CI: 2.01-4.56; P< 0.001). The difference in SRC prevalence remained statistically significant in a sensitivity analysis, after excluding the study with the largest sample size (OR: 2.71; 95% CI: 1.91-3.84; P< 0.001).
Our meta-analysis demonstrated a 3-fold increased prevalence of SRC in patients with AAA compared to no-AAA cases, indicating that the pathogenic processes underlying SRC and AAA could share a common pathophysiologic mechanism. Thus, patients with SRC could be considered at high risk for AAA formation, potentially warranting an earlier AAA screening.
背景-目的：先前的研究表明，患有主动脉疾病（包括腹主动脉瘤（AAA））的患者中，单纯性肾囊肿（SRC）的患病率更高。因此，本研究的目的是系统地综述所有现有文献，并探讨 AAA 患者是否更有可能患有 SRC。
本研究按照 PRISMA 指南进行。使用随机效应模型进行荟萃分析，并使用 I 平方评估异质性。合成比值比（OR）及其相应的 95％置信区间（CI），以比较 AAA 与非-AAA 病例之间几种患者特征的患病率。
11 项回顾性研究，9 项对比研究（AAA 与非-AAA 组）和 3 项单臂研究（AAA 组）纳入本荟萃分析，共纳入接受计算机断层血管造影术的患者（AAA：N=2297 例；非-AAA：N=35873 例），这些患者因除 AAA 以外的原因接受筛查或术前评估。AAA 患者和非-AAA 患者 SRC 的累积发生率分别为 55％（95％CI：49％-61％）和 32％（95％CI：22％-42％），AAA 患者 SRC 的几率明显更高（OR：3.02；95％CI：2.01-4.56；P<0.001）。在排除样本量最大的研究后，敏感性分析结果显示 SRC 患病率的差异仍具有统计学意义（OR：2.71；95％CI：1.91-3.84；P<0.001）。
我们的荟萃分析表明，与非-AAA 病例相比，AAA 患者 SRC 的患病率增加了 3 倍，这表明 SRC 和 AAA 背后的发病机制可能具有共同的病理生理机制。因此，SRC 患者可能被认为 AAA 形成的风险较高，可能需要更早的 AAA 筛查。
