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常染色体显性遗传多囊肾病患者颅内动脉瘤破裂风险的相关临床因素。

Clinical Factors Associated with the Risk of Intracranial Aneurysm Rupture in Autosomal Dominant Polycystic Kidney Disease.

机构信息

Department of Neurology, Jeonbuk National University Hospital and Medical School, Jeonju, Republic of Korea.

Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.

出版信息

Cerebrovasc Dis. 2021;50(3):339-346. doi: 10.1159/000513709. Epub 2021 Mar 11.

DOI:10.1159/000513709

PMID:33706308

Abstract

BACKGROUND

The occurrence of intracranial aneurysms is higher in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the healthy population. However, research concerning the factors related to the risk of intracranial aneurysm rupture in patients with ADPKD is still insufficient.

OBJECTIVES

The aim of the study was to investigate the prevalence of intracranial aneurysms and aneurysmal subarachnoid hemorrhage (SAH) and to analyze the systemic factors associated with high-risk aneurysms in patients with ADPKD.

METHODS

We screened patients who underwent cerebral angiography between January 2007 and May 2017 in the ADPKD registry. Patients were examined for the presence of intracranial aneurysms and subsequently reclassified into 3 groups based on the risk of aneurysmal rupture: the aneurysm-negative (group 1), low-risk aneurysm (group 2), or high-risk aneurysm (group 3). Various systemic factors were compared, and independent factors associated with high-risk aneurysms were analyzed.

RESULTS

Among the 926 patients, 148 (16.0%) had intracranial aneurysms and 11 (1.2%) had previous aneurysmal SAH. Patients with intracranial aneurysms were further classified into group 2 (low-risk aneurysms, 15.5%) or group 3 (high-risk aneurysms, 84.5%). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p = 0.004), female sex (OR 3.13, 95% CI 1.94-5.0 6, p < 0.001), dolichoectasia (OR 8.57, 95% CI 1.53-48.17, p = 0.015), and mitral inflow deceleration time (DT) (OR 1.01, 95% CI 1.00-1.01, p = 0.046) were independently associated with high-risk aneurysms, whereas hypercholesterolemia (OR 0.46, 95% CI 0.29-0.72, p = 0.001) was negatively associated.

CONCLUSION

In the present study among patients with ADPKD, the prevalence of intracranial aneurysms and aneurysmal SAH was 16 and 1.2%, respectively. Age, female sex, dolichoectasia, and mitral inflow DT were positively associated with high-risk aneurysms, whereas hypercholesterolemia was negatively associated. A subsequent large-scaled longitudinal study is needed to define the plausibility of the clinical parameters.

摘要

背景

常染色体显性多囊肾病（ADPKD）患者颅内动脉瘤的发生率高于健康人群。然而，关于 ADPKD 患者颅内动脉瘤破裂风险相关因素的研究仍不够充分。

目的

本研究旨在探讨 ADPKD 患者颅内动脉瘤及蛛网膜下腔出血（SAH）的患病率，并分析与颅内动脉瘤高危相关的系统性因素。

方法

我们对 2007 年 1 月至 2017 年 5 月期间在 ADPKD 登记处行脑血管造影的患者进行了筛选。对患者进行颅内动脉瘤的检查，随后根据动脉瘤破裂的风险将患者重新分为 3 组：无动脉瘤（第 1 组）、低危动脉瘤（第 2 组）或高危动脉瘤（第 3 组）。比较了各种系统性因素，并分析了与高危动脉瘤相关的独立因素。

结果

在 926 例患者中，148 例（16.0%）存在颅内动脉瘤，11 例（1.2%）存在既往动脉瘤性 SAH。颅内动脉瘤患者进一步分为第 2 组（低危动脉瘤，15.5%）或第 3 组（高危动脉瘤，84.5%）。年龄（比值比[OR]1.03，95%置信区间[CI]1.01-1.05，p=0.004）、女性（OR 3.13，95%CI 1.94-5.06，p<0.001）、梭形动脉瘤（OR 8.57，95%CI 1.53-48.17，p=0.015）和二尖瓣流入减速时间（DT）（OR 1.01，95%CI 1.00-1.01，p=0.046）与高危动脉瘤独立相关，而高胆固醇血症（OR 0.46，95%CI 0.29-0.72，p=0.001）与高危动脉瘤负相关。