Department of Neurology, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Republic of Korea.
J Neurol Neurosurg Psychiatry. 2012 Nov;83(11):1100-3. doi: 10.1136/jnnp-2012-302538. Epub 2012 Aug 30.
Subarachnoid haemorrhage (SAH) is the most devastating cerebrovascular disease. Cigarette smoking is one of the established risk factors for SAH, but the risk of SAH has not been properly elucidated in relation to smoking cessation.
We performed a nationwide multicentre case control study involving 33 hospitals in Korea. A total of 426 SAH cases and 426 age and sex matched controls were enrolled. We obtained detailed information on lifestyle, medical history and, in particular, smoking habits from participants using structured questionnaires.
148 SAH patients (37.4%) were current smokers compared with 103 (24.2%) controls, giving an adjusted OR of 2.84 (95% CI, 1.63 to 4.97) after controlling for possible confounders. Based on cumulative dose of smoking (pack years), the risk of SAH was found to increase in a dose-responsive fashion. Smoking cessation (≥5 years) caused a reduction in SAH to 59% (p<0.05). However, participants with a history of heavy smoking (≥20 cigarettes per day) had a 2.3 times increased risk of SAH compared with participants who had never smoked (p<0.05).
We have demonstrated that cigarette smoking increases the risk of SAH, but smoking cessation decreases the risk in a time dependent manner, although this beneficial effect may be diminished in previous heavy smokers. To forestall tragic SAH events, our results call for more global and vigorous efforts for people to stop smoking.
蛛网膜下腔出血（SAH）是最具破坏性的脑血管病。吸烟是 SAH 的既定危险因素之一，但关于戒烟与 SAH 风险的关系尚未得到充分阐明。
我们进行了一项全国性多中心病例对照研究，涉及韩国的 33 家医院。共纳入 426 例 SAH 病例和 426 例年龄和性别匹配的对照。我们使用结构化问卷从参与者那里获得有关生活方式、病史的详细信息，特别是吸烟习惯。
148 例 SAH 患者（37.4%）为当前吸烟者，而 103 例对照者（24.2%）为当前吸烟者，在校正可能的混杂因素后，调整后的 OR 为 2.84（95% CI，1.63 至 4.97）。基于吸烟的累积剂量（包年），发现 SAH 的风险呈剂量反应式增加。戒烟（≥5 年）可使 SAH 风险降低 59%（p<0.05）。然而，与从不吸烟者相比，有重度吸烟史（≥20 支/天）的参与者发生 SAH 的风险增加了 2.3 倍（p<0.05）。
我们已经证明吸烟会增加 SAH 的风险，但戒烟会以时间依赖的方式降低风险，尽管这种有益的效果可能会在以前的重度吸烟者中减弱。为了防止悲惨的 SAH 事件发生，我们的结果呼吁人们更加积极地采取全球性的戒烟措施。
