Mirbagheri Andia, Rinkel Gabriel J E, Berneburg Mark, Etminan Nima
Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim , Germany.
Department of Dermatology, University Hospital Regensburg, Regensburg , Germany.
Neurosurgery. 2025 Feb 1;96(2):396-401. doi: 10.1227/neu.0000000000003091. Epub 2024 Jul 1.
Inflammation is a key pathomechanism for growth and rupture of intracranial aneurysms. Anti-inflammatory mechanisms may reduce rupture of intracranial aneurysms and the incidence of aneurysmal subarachnoid hemorrhage (SAH). Ultraviolet (UV) radiation from sunlight exposure induces systemic anti-inflammatory responses through immunosuppressive mechanisms. We studied whether SAH incidence is associated with UV radiation.
Global SAH incidence, time trends, and regional differences from 32 countries were linked to UV radiation data from the Tropospheric Emission Monitoring Internet Service. Odds between low vs high UV exposure and SAH incidence were calculated. Correlation analysis was performed using R (R 4.1.2).
SAH incidences ranged from 1.3 to 27 per 100 000 patient-years (p-y) and UV index from 1.76 to 11.27. The correlation coefficient (rho) between SAH incidence and UV index was -0.48 ( P = .012). SAH incidence was highest in Japan (13.7-27.9 p-y) with an UV index 6.28. UV index was highest in Chile 11.27 with a lower SAH incidence (3.8-4.8 p-y). The lowest UV index 1.76 was seen in Iceland with higher SAH incidence (9.8 p-y).Within Europe, regions with higher UV indices reported lower SAH incidences (Northwest Europe: SAH incidence p-y 8.61/UV index 2.85; Southeast Europe: SAH incidence p-y 7.37/UV index 4.65) with a significant inverse correlation (rho = -0.68, P = .004) and not a significant correlation between non-European countries (rho = -0.43, P = .19). Low exposure of UV radiation in global regions predicted higher than median incidences of SAH with an odds ratio 5.13 (95% CIs 1.02-31.5).
The incidence of SAH is inversely associated with UV radiation. Further studies should assess the actual UV exposure in relation to SAH incidence and potential biological explanations for the relation we found.
炎症是颅内动脉瘤生长和破裂的关键病理机制。抗炎机制可能会降低颅内动脉瘤破裂及动脉瘤性蛛网膜下腔出血（SAH）的发生率。阳光照射产生的紫外线（UV）辐射通过免疫抑制机制诱导全身抗炎反应。我们研究了SAH发生率是否与紫外线辐射有关。
将32个国家的全球SAH发生率、时间趋势和地区差异与对流层排放监测互联网服务的紫外线辐射数据相关联。计算低紫外线暴露与高紫外线暴露和SAH发生率之间的比值比。使用R（R 4.1.2）进行相关性分析。
SAH发生率为每100000患者年1.3至27例，紫外线指数为1.76至11.27。SAH发生率与紫外线指数之间的相关系数（rho）为-0.48（P = 0.012）。日本的SAH发生率最高（13.7 - 27.9例/100000患者年），紫外线指数为6.28。智利的紫外线指数最高，为11.27，SAH发生率较低（3.8 - 4.8例/100000患者年）。冰岛的紫外线指数最低，为1.76，SAH发生率较高（9.8例/100000患者年）。在欧洲，紫外线指数较高的地区SAH发生率较低（西北欧：SAH发生率为8.61例/100000患者年，紫外线指数为2.85；东南欧：SAH发生率为7.37例/100000患者年，紫外线指数为4.65），呈显著负相关（rho = -0.68，P = 0.004），而非欧洲国家之间无显著相关性（rho = -0.43，P = 0.19）。全球低紫外线辐射暴露地区的SAH发生率高于中位数，比值比为5.13（95%可信区间为1.02 - 31.5）。
SAH的发生率与紫外线辐射呈负相关。进一步的研究应评估与SAH发生率相关的实际紫外线暴露情况以及对我们所发现关系的潜在生物学解释。
