Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
Clinical Research Center, Nagasaki University School of Medicine, Nagasaki, Japan.
Neurosurg Rev. 2021 Oct;44(5):2611-2618. doi: 10.1007/s10143-020-01435-8. Epub 2020 Nov 11.
Spontaneous subarachnoid hemorrhage (SAH) occurs due to intracranial aneurysm rupture in most cases. Rheumatic disease may cause vessel wall inflammation, which can increase the risk of rupture. However, the characteristics of SAH with rheumatic disease are unknown. This study aimed to evaluate SAH features in patients with rheumatic disease. We retrospectively analyzed clinical data of 5066 patients from the Nagasaki SAH Registry Study who had been diagnosed with aneurysmal SAH between 2001 and 2018. We evaluated the SAH characteristics in patients with rheumatic disease using multivariable logistic regression analysis. In total, 102 patients (2.0%, 11 men and 91 women, median age 69.0 [57.0-75.5]) had rheumatic disease. In these patients, univariate logistic regression analysis showed that sex, hypertension, family history of SAH, smoking history, World Federation of Neurosurgical Societies grade on admission, aneurysm size, multiple aneurysms, treatment, and symptomatic spasms were associated with SAH. Multivariable logistic regression analysis showed that characteristics independently associated with SAH in rheumatic disease were female sex (odds ratio [OR] 3.38; 95% confidence interval [CI] 1.81-6.93, P < 0.001), hypertension (OR 0.60; 95% CI 0.40-0.90, P = 0.012), family history of SAH (OR 0.18; 95% CI 0.01-0.80, P = 0.020), small ruptured aneurysms (OR 1.50; 95% CI 1.02-2.24, P = 0.048), and multiple aneurysms (OR 1.69; 95% CI 1.09-2.58, P = 0.021) in comparison with SAH without rheumatic disease. In conclusion, SAH in patients with rheumatic disease was characterized by small multiple aneurysms, regardless of the low incidence of hypertension and family history of SAH.
自发性蛛网膜下腔出血（SAH）在大多数情况下是由于颅内动脉瘤破裂引起的。风湿性疾病可导致血管壁炎症，从而增加破裂的风险。然而，风湿性疾病引起的 SAH 的特征尚不清楚。本研究旨在评估风湿性疾病患者的 SAH 特征。我们回顾性分析了 2001 年至 2018 年间在长崎 SAH 登记研究中诊断为动脉瘤性 SAH 的 5066 例患者的临床资料。我们使用多变量逻辑回归分析评估了风湿性疾病患者的 SAH 特征。共有 102 例（2.0%，11 例男性和 91 例女性，中位年龄 69.0[57.0-75.5]）患有风湿性疾病。在这些患者中，单因素逻辑回归分析显示，性别、高血压、SAH 家族史、吸烟史、入院时世界神经外科学会分级、动脉瘤大小、多发动脉瘤、治疗方法和症状性痉挛与 SAH 相关。多变量逻辑回归分析显示，风湿性疾病与 SAH 相关的特征独立因素为女性（比值比[OR]3.38；95%置信区间[CI]1.81-6.93，P<0.001）、高血压（OR 0.60；95%CI 0.40-0.90，P=0.012）、SAH 家族史（OR 0.18；95%CI 0.01-0.80，P=0.020）、小破裂动脉瘤（OR 1.50；95%CI 1.02-2.24，P=0.048）和多发动脉瘤（OR 1.69；95%CI 1.09-2.58，P=0.021）。总之，与无风湿性疾病的 SAH 相比，风湿性疾病患者的 SAH 特征为小的多发动脉瘤，尽管高血压和 SAH 家族史的发生率较低。
