Nieuwkamp Dennis J, Setz Larissa E, Algra Ale, Linn Francisca H H, de Rooij Nicolien K, Rinkel Gabriël J E
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands.
Lancet Neurol. 2009 Jul;8(7):635-42. doi: 10.1016/S1474-4422(09)70126-7. Epub 2009 Jun 6.
In a systematic review, published in 1997, we found that the case fatality of aneurysmal subarachnoid haemorrhage (SAH) decreased during the period 1960-95. Because diagnostic and treatment strategies have improved and new studies from previously non-studied regions have been published since 1995, we did an updated meta-analysis to assess changes in case fatality and morbidity and differences according to age, sex, and region.
A new search of PubMed with predefined inclusion criteria for case finding and diagnosis identified reports on prospective population-based studies published between January, 1995, and July, 2007. The studies included in the previous systematic review were reassessed with the new inclusion criteria. Changes in case fatality over time and the effect of age and sex were quantified with weighted linear regression. Regional differences were analysed with linear regression analysis, and the regions of interest were subsequently defined as reference regions and compared with the other regions.
33 studies (23 of which were published in 1995 or later) were included that described 39 study periods. These studies reported on 8739 patients, of whom 7659 [88%] were reported on after 1995. 11 of the studies that were included in the previous review did not meet the current, more stringent, inclusion criteria. The mean age of patients had increased in the period 1973 to 2002 from 52 to 62 years. Case fatality varied from 8.3% to 66.7% between studies and decreased 0.8% per year (95% CI 0.2 to 1.3). The decrease was unchanged after adjustment for sex, but the decrease per year was 0.4% (-0.5 to 1.2) after adjustment for age. Case fatality was 11.8% (3.8 to 19.9) lower in Japan than it was in Europe, the USA, Australia, and New Zealand. The unadjusted decrease in case fatality excluding the data for Japan was 0.6% per year (0.0 to 1.1), a 17% decrease over the three decades. Six studies reported data on case morbidity, but these were insufficient to assess changes over time.
Despite an increase in the mean age of patients with SAH, case-fatality rates have decreased by 17% between 1973 and 2002 and show potentially important regional differences. This decrease coincides with the introduction of improved management strategies.
Netherlands Organisation for Scientific Research; ZonMw.
在1997年发表的一项系统评价中，我们发现1960 - 1995年期间动脉瘤性蛛网膜下腔出血（SAH）的病死率有所下降。由于自1995年以来诊断和治疗策略有所改进，并且有来自以前未研究地区的新研究发表，我们进行了一项更新的荟萃分析，以评估病死率和发病率的变化以及根据年龄、性别和地区的差异。
使用预定义的病例查找和诊断纳入标准对PubMed进行新的检索，以确定1995年1月至2007年7月期间发表的基于人群的前瞻性研究报告。以前系统评价中纳入的研究根据新的纳入标准重新进行评估。通过加权线性回归对病死率随时间的变化以及年龄和性别的影响进行量化。使用线性回归分析分析地区差异，随后将感兴趣的地区定义为参考地区并与其他地区进行比较。
纳入了33项研究（其中23项发表于1995年或之后），描述了39个研究时期。这些研究报告了8739例患者，其中7659例（88%）是1995年之后报告的。之前综述中纳入的11项研究不符合当前更严格的纳入标准。1973年至2002年期间患者的平均年龄从52岁增加到了62岁。不同研究之间的病死率从8.3%到66.7%不等，每年下降0.8%（95%CI 0.2至1.3）。调整性别后下降情况不变，但调整年龄后每年下降0.4%（-0.5至1.2）。日本的病死率比欧洲、美国、澳大利亚和新西兰低11.8%（3.8至19.9）。排除日本数据后未经调整的病死率每年下降0.6%（0.0至1.1），三十年间下降了17%。六项研究报告了病例发病率数据，但这些数据不足以评估随时间的变化。
尽管SAH患者的平均年龄有所增加，但1973年至2002年期间病死率下降了17%，并显示出潜在的重要地区差异。这种下降与改进的管理策略的引入相吻合。
荷兰科学研究组织；荷兰卫生与社会福利部卫生研究与发展司。
