Levey A S, Pauker S G, Kassirer J P
N Engl J Med. 1983 Apr 28;308(17):986-94. doi: 10.1056/NEJM198304283081702.
Patients with polycystic kidney disease are at increased risk of subarachnoid hemorrhage from rupture of intracranial aneurysms. We used decision analysis to assess whether or not patients with polycystic kidney disease should undergo routine cerebral arteriography for intracranial aneurysms and prophylactic surgery, if an aneurysm is detected. We incorporated published data on the prevalence of intracranial aneurysms in patients with polycystic kidney disease, the annual rate of aneurysmal rupture, the risk of grave complications of rupture, and the likelihood of grave complications of arteriography and prophylactic surgery. Outcomes were assessed as years of survival, and benefit was calculated as the gain in survival. Our analysis shows that arteriography should not be carried out routinely because its benefit exceeds one year only if the prevalence of aneurysm exceeds 30 per cent, if the surgical complication rate is 1 per cent or less, and if the patient is under 25 years of age. If newer noninvasive tests, such as digital-subtraction angiography, prove to identify reliably patients who are highly likely to have a cerebral aneurysm, routine screening with these tests will be warranted in patients with polycystic kidney disease.
多囊肾病患者因颅内动脉瘤破裂而发生蛛网膜下腔出血的风险增加。我们采用决策分析来评估多囊肾病患者是否应接受常规脑动脉造影以检测颅内动脉瘤，以及如果检测到动脉瘤是否应进行预防性手术。我们纳入了已发表的关于多囊肾病患者颅内动脉瘤患病率、动脉瘤年破裂率、破裂严重并发症风险以及动脉造影和预防性手术严重并发症可能性的数据。结果以生存年数评估，益处以生存获益计算。我们的分析表明，不应常规进行动脉造影，因为仅当动脉瘤患病率超过30%、手术并发症率为1%或更低且患者年龄在25岁以下时，其益处才超过一年。如果更新的非侵入性检查，如数字减影血管造影，被证明能可靠地识别出极有可能患有脑动脉瘤的患者，那么对多囊肾病患者进行这些检查的常规筛查将是必要的。
