Ghoche Maged T, Maroufi Seyed Farzad, El Maalouf Joy M, Pachón-Londoño Maria José, Nguyen Brandon A, Halpin Brooke S, Turcotte Evelyn L, Patra Devi, Krishna Chandan, Wang Zhen, Turkmani Ali, Ogilvy Christopher S, Bendok Bernard R
Departments of1Neurological Surgery.
2Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix.
J Neurosurg. 2024 Dec 27;142(5):1397-1405. doi: 10.3171/2024.7.JNS241015. Print 2025 May 1.
While the relationship between smoking and subarachnoid hemorrhage is well established, data regarding the probability of detecting unruptured intracranial aneurysms (UIAs) in smokers remain sparse. The aim of this systematic review and meta-analysis is to provide a comprehensive understanding of the relationship between smoking and the likelihood of identifying UIAs in healthy asymptomatic patients who underwent brain imaging for indications unrelated to UIAs.
A systematic review was conducted following the PRISMA guidelines. The PubMed and Scopus databases were searched for studies published before March 2024 that reported on the presence of UIAs in healthy asymptomatic patients who had undergone brain imaging for indications unrelated to UIAs. Three independent reviewers assessed the eligibility of all retrieved studies. Risk of bias for the included observational studies was assessed using the methodological index for non-randomized studies. Data on UIA prevalence, smoking status, and patient and aneurysm characteristics were extracted. The association between smoking and the presence of UIA was studied. A prevalence proportional meta-analysis was conducted across the included studies. A meta-analysis was performed with a random-effects model by using summary statistics from the included studies.
Six studies involving 47,788 patients who had undergone brain imaging were identified for quantitative analysis. The pooled UIA prevalence in the sample was 3.07% (95% CI 2.27%-4.16%). Patients who smoked had higher rates of aneurysm detection than the patients who did not smoke (pooled prevalence of 2.96%, 95% CI 2.68%-3.27% vs 2.23%, 95% CI 2.08%-2.39%). Although the relation between the two was not statistically significant (p = 0.06), smoking was associated with higher odds for UIA detection, yielding an OR of 1.34 (95% CI 1.07-1.67) with an I2 value of 53%.
This study suggests a potentially higher risk of UIAs in patients who smoked than in those who never smoked. However, the results of this meta-analysis revealed that smoking was not statistically associated with higher UIA detection. This result could be explained by the limited number of studies published on this topic. If these findings reach statistical significance in future larger studies, it could justify revising guidelines to include cigarette smokers in intracranial aneurysm screening.
虽然吸烟与蛛网膜下腔出血之间的关系已得到充分证实，但关于吸烟者中检测到未破裂颅内动脉瘤（UIA）的概率的数据仍然稀少。本系统评价和荟萃分析的目的是全面了解吸烟与在因与UIA无关的指征而接受脑成像检查的健康无症状患者中识别UIA的可能性之间的关系。
按照PRISMA指南进行系统评价。在PubMed和Scopus数据库中检索2024年3月之前发表的、报告了因与UIA无关的指征而接受脑成像检查的健康无症状患者中UIA存在情况的研究。三位独立评审员评估所有检索到的研究的 eligibility。使用非随机研究的方法学指数评估纳入的观察性研究的偏倚风险。提取关于UIA患病率、吸烟状况以及患者和动脉瘤特征的数据。研究吸烟与UIA存在之间的关联。对纳入的研究进行患病率比例荟萃分析。使用纳入研究的汇总统计数据，通过随机效应模型进行荟萃分析。
确定了六项涉及47788例接受脑成像检查患者的研究进行定量分析。样本中UIA的合并患病率为3.07%（95%CI 2.27%-4.16%）。吸烟患者的动脉瘤检出率高于不吸烟患者（合并患病率分别为2.96%，95%CI 2.68%-3.27%和2.23%，95%CI 2.08%-2.39%）。虽然两者之间的关系无统计学意义（p = 0.06），但吸烟与UIA检测的较高几率相关，OR为1.34（95%CI 1.07-1.67），I2值为53%。
本研究表明，吸烟患者发生UIA的风险可能高于从不吸烟的患者。然而，这项荟萃分析的结果显示，吸烟与较高的UIA检测率无统计学关联。这一结果可能是由于关于该主题发表的研究数量有限。如果这些发现在未来更大规模的研究中具有统计学意义，那么可能有理由修订指南，将吸烟者纳入颅内动脉瘤筛查。
