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自體顯性多囊性腎病變之血管相關併發症

摘要


自體顯性多囊性腎病變(autosomal dominant polycystic kidney disease, ADPKD)為最常見的遺傳性腎臟疾病。腎臟內水泡的持續生長導致腎臟體積增大,日積月累導致腎臟衰竭。自體顯性多囊性腎病變病患可能同時存在血管相關之併發疾病,比如顱內動脈瘤可在近一成之無症狀之患者身上意外發現。自體顯性多囊性腎病變可依基因PKD1與PKD2作為分類。二者皆有因基因突變導致平滑肌細胞內鈣離子傳導變化,也因而導致血管構造改變容易發生動脈瘤。顱動脈瘤之剝離或破裂之發生更加重不良預後以及死亡。其他血管瘤例如胸主動脈瘤,腹腔主動脈瘤,主動脈弓剝離等,雖有相當發生率但在此族群病患相對來的低。本編文章著重於如何篩選,診斷及治療有合併顱動脈瘤之自體顯性多囊性腎病變病患。治療方案應取決於相關專家照會診以及針對動脈瘤病灶位置,病患年紀及其它共併症取得對病患最佳利與弊之決策。

參考文獻


Lee PW, Chien CC, Yang WC, et al. Epidemiology and mortality in dialysis patients with and without polycystic kidney disease: a national study in Taiwan. J Nephrol 2013;26:755-62.
Yang JY, Chen L, Chao CT, et al. Outcome Comparisons Between Patients on Peritoneal Dialysis With and Without Polycystic Kidney Disease: A Nationwide Matched Cohort Study. Medicine (Baltimore) 2015;94:e2166.
Yang JY, Chen L, Chao CT, et al. Comparative Study of Outcomes among Patients with Polycystic Kidney Disease on Hemodialysis and Peritoneal Dialysis. Sci Rep 2015;5:12816.
Chapman AB, Devuyst O, Eckardt KU, et al. Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2015;88:17-27.
Qian Q, Hunter LW, Li M, et al. Pkd2 haploinsufficiency alters intracellular calcium regulation in vascular smooth muscle cells. Hum Mol Genet 2003;12:1875-80.

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