Can Anil, Castro Victor M, Ozdemir Yildirim H, Dagen Sarajune, Yu Sheng, Dligach Dmitriy, Finan Sean, Gainer Vivian, Shadick Nancy A, Murphy Shawn, Cai Tianxi, Savova Guergana, Dammers Ruben, Weiss Scott T, Du Rose
From the Department of Neurosurgery (A.C., Y.H.O., S.D., R. Du), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.C., R. Dammers), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Research Information Systems and Computing (V.M.C., V.G., S.M.), Partners Healthcare, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R. Du), Brigham and Women's Hospital, Boston, MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Informatics Program (D.D., S.F., G.S.), Boston Children's Hospital; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard School of Public Health, Boston, MA.
Neurology. 2017 Sep 26;89(13):1408-1415. doi: 10.1212/WNL.0000000000004419. Epub 2017 Aug 30.
Although smoking is a known risk factor for intracranial aneurysm (IA) rupture, the exact relationship between IA rupture and smoking intensity and duration, as well as duration of smoking cessation, remains unknown.
In this case-control study, we analyzed 4,701 patients with 6,411 IAs diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We divided individuals into patients with ruptured aneurysms and controls with unruptured aneurysms. We performed univariable and multivariable logistic regression analyses to determine the association between smoking status and ruptured IAs at presentation. In a subgroup analysis among former and current smokers, we assessed the association between ruptured aneurysms and number of packs per day, duration of smoking, and duration since smoking cessation.
In multivariable analysis, current (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.89-2.59) and former smoking status (OR 1.56, 95% CI 1.31-1.86) were associated with rupture status at presentation compared with never smokers. In a subgroup analysis among current and former smokers, years smoked (OR 1.02, 95% CI 1.01-1.03) and packs per day (OR 1.46, 95% CI 1.25-1.70) were significantly associated with ruptured aneurysms at presentation, whereas duration since cessation among former smokers was not significant (OR 1.00, 95% CI 0.99-1.02).
Current cigarette smoking, smoking intensity, and smoking duration are significantly associated with ruptured IAs at presentation. However, the significantly increased risk persists after smoking cessation, and smoking cessation does not confer a reduced risk of aneurysmal subarachnoid hemorrhage beyond that of reducing the cumulative dose.
虽然吸烟是颅内动脉瘤（IA）破裂的已知危险因素，但IA破裂与吸烟强度、持续时间以及戒烟持续时间之间的确切关系仍不清楚。
在这项病例对照研究中，我们分析了1990年至2016年间在布莱根妇女医院和麻省总医院诊断出的4701例患有6411个IA的患者。我们将个体分为动脉瘤破裂患者和未破裂动脉瘤对照组。我们进行了单变量和多变量逻辑回归分析，以确定就诊时吸烟状态与破裂IA之间的关联。在既往吸烟者和当前吸烟者的亚组分析中，我们评估了破裂动脉瘤与每日吸烟包数、吸烟持续时间以及戒烟后持续时间之间的关联。
在多变量分析中，与从不吸烟者相比，当前吸烟状态（比值比[OR]2.21，95%置信区间[CI]1.89 - 2.59）和既往吸烟状态（OR 1.56，95%CI 1.31 - 1.86）与就诊时的破裂状态相关。在当前吸烟者和既往吸烟者的亚组分析中，吸烟年数（OR 1.02，95%CI 1.01 - 1.03）和每日吸烟包数（OR 1.46，95%CI 1.25 - 1.70）与就诊时破裂动脉瘤显著相关，而既往吸烟者戒烟后的持续时间则不显著（OR 1.00，95%CI 0.99 - 1.02）。
当前吸烟、吸烟强度和吸烟持续时间与就诊时破裂的IA显著相关。然而，戒烟后风险仍显著增加，且戒烟并不能降低动脉瘤性蛛网膜下腔出血的风险，其降低幅度不超过减少累积剂量的幅度。
