Juvela Seppo, Lehto Hanna
From the Department of Clinical Neurosciences (S.J.), University of Helsinki; and Department of Neurosurgery (H.L.), Helsinki University Central Hospital, Finland.
Neurology. 2015 Feb 3;84(5):456-63. doi: 10.1212/WNL.0000000000001207. Epub 2015 Jan 7.
We investigated all-cause mortality and risk factors of death of patients with unruptured intracranial aneurysms (UIAs) in a long-term follow-up study.
A total of 142 patients with 181 UIAs diagnosed between 1956 and 1978 when UIAs were not treated were included in this study. Patients were followed until death or until 2011 to 2012. Mortality rates and risk factors were studied with Kaplan-Meier survival analysis and the Cox proportional hazards regression models.
During 3,530 person-years, 113 (80%) had died, giving an average annual mortality of 3.2%. Of them, 19 (17%) died of aneurysm rupture from the index UIA, 6 (5%) of other aneurysm-related causes, and 2 (2%) of unspecified subarachnoid hemorrhage. The remaining 86 died of causes unrelated to intracranial aneurysms. The cumulative death rate was 20% (95% confidence interval 14%-27%) at 10 years and 60% (52%-68%) at 30 years. Independent risk factors for subsequent death were patient age (adjusted hazard ratio 1.09 per year, 95% confidence interval 1.05-1.12, p < 0.001), male sex (2.81, 1.59-4.96, p < 0.001), heavy alcohol use (4.22, 2.22-8.02, p < 0.001), and cigarette smoking (1.72, 0.97-3.07, p = 0.064). History of hypertension, family history of subarachnoid hemorrhage, and diameter of UIA predicted death only in univariable analysis.
In patients of working age with a UIA, alcohol consumption and cigarette smoking are modifiable risk factors for untimely death through several causes and should be taken into account when treatment is considered.
在一项长期随访研究中，我们调查了未破裂颅内动脉瘤（UIA）患者的全因死亡率及死亡风险因素。
本研究纳入了1956年至1978年间诊断出181个UIA且未接受治疗的142例患者。对患者进行随访直至死亡或直至2011年至2012年。采用Kaplan-Meier生存分析和Cox比例风险回归模型研究死亡率及风险因素。
在3530人年期间，113例（80%）患者死亡，平均年死亡率为3.2%。其中，19例（17%）死于索引UIA的动脉瘤破裂，6例（5%）死于其他与动脉瘤相关的原因，2例（2%）死于未明确的蛛网膜下腔出血。其余86例死于与颅内动脉瘤无关的原因。10年时累积死亡率为20%（95%置信区间14%-27%），30年时为60%（52%-68%）。后续死亡的独立风险因素为患者年龄（调整后风险比每年1.09，95%置信区间1.05-1.12，p<0.001）、男性（2.81，1.59-4.96，p<0.001）、大量饮酒（4.22，2.22-8.02，p<0.001）和吸烟（1.72，0.97-3.07，p=0.064）。高血压病史、蛛网膜下腔出血家族史和UIA直径仅在单变量分析中预测死亡。
在患有UIA的工作年龄患者中，饮酒和吸烟是可通过多种原因导致过早死亡的可改变风险因素，在考虑治疗时应予以考虑。
