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动脉瘤性蛛网膜下腔出血的流行病学、危险因素和发病机制

Authors
Robert J Singer, MD
Christopher S Ogilvy, MD
Guy Rordorf, MD
Section Editor
Jose Biller, MD, FACP, FAAN, FAHA
Deputy Editor
Janet L Wilterdink, MD
Translators
王向宇, 主任医师，教授

引言

20%的脑卒中都为出血性疾病，蛛网膜下腔出血(subarachnoid hemorrhage, SAH)和脑内出血各占10%。大多数SAH都是由囊性动脉瘤破裂导致。其他原因包括：创伤、动静脉畸形/瘘、血管炎、颅内动脉夹层、淀粉样血管病、出血素质和使用违禁药物(特别是可卡因和苯丙胺类)。

本文将总结动脉瘤性SAH的流行病学和危险因素。未破裂动脉瘤的流行病学和处理，以及动脉瘤性SAH的临床特征、诊断和治疗将单独讨论。感染性动脉瘤和非动脉瘤性SAH也将单独讨论。 (参见“未破颅内动脉瘤”和“动脉瘤性蛛网膜下腔出血的病因、临床表现和诊断”和“动脉瘤性蛛网膜下腔出血的治疗”和“感染性动脉瘤概述”和“非动脉瘤性蛛网膜下腔出血”和“中脑周围非动脉瘤性蛛网膜下腔出血”)

流行病学

动脉瘤性SAH的发病率存在地域差异。据报道，美国的发病率为10-15例/100,000人[1,2]。中国(2/100,000)及中美洲和南美洲(4/100,000)的发病率要低得多，而芬兰和日本的病率较高(19-23/100,000)[3,4]。

动脉瘤破裂的平均年龄为55岁[5]。虽然大多数动脉瘤性SAH发生在40-60岁的人群中，但幼儿和老年人也可受累[6,7]。非洲裔美国人的风险似乎高于白种美国人[8]。女性动脉瘤性SAH的发病率略高于男性，这可能与激素状态有关(参见下文‘雌激素缺乏’)[6,9]。

危险因素

大多数SAH都是由颅内动脉瘤破裂引起。因此，动脉瘤形成的危险因素与SAH的危险因素重叠。主要与颅内动脉瘤形成有关的危险因素将单独讨论。 (参见“未破颅内动脉瘤”)

          

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Literature review current through: 2017-06 . | This topic last updated: 2013-09-26.
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References
Top
  1. Labovitz DL, Halim AX, Brent B, et al. Subarachnoid hemorrhage incidence among Whites, Blacks and Caribbean Hispanics: the Northern Manhattan Study. Neuroepidemiology 2006; 26:147.
  2. Shea AM, Reed SD, Curtis LH, et al. Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003. Neurosurgery 2007; 61:1131.
  3. Ingall T, Asplund K, Mähönen M, Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 2000; 31:1054.
  4. de Rooij NK, Linn FH, van der Plas JA, et al. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78:1365.
  5. Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994; 25:2315.
  6. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29:251.
  7. Jordan LC, Johnston SC, Wu YW, et al. The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study. Stroke 2009; 40:400.
  8. Broderick JP, Brott T, Tomsick T, et al. The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med 1992; 326:733.
  9. Sarti C, Tuomilehto J, Salomaa V, et al. Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke 1991; 22:848.
  10. Vlak MH, Rinkel GJ, Greebe P, et al. Lifetime risks for aneurysmal subarachnoid haemorrhage: multivariable risk stratification. J Neurol Neurosurg Psychiatry 2013; 84:619.
  11. Knekt P, Reunanen A, Aho K, et al. Risk factors for subarachnoid hemorrhage in a longitudinal population study. J Clin Epidemiol 1991; 44:933.
  12. Anderson CS, Feigin V, Bennett D, et al. Active and passive smoking and the risk of subarachnoid hemorrhage: an international population-based case-control study. Stroke 2004; 35:633.
  13. Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36:2773.
  14. Feigin V, Parag V, Lawes CM, et al. Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants. Stroke 2005; 36:1360.
  15. Sandvei MS, Romundstad PR, Müller TB, et al. Risk factors for aneurysmal subarachnoid hemorrhage in a prospective population study: the HUNT study in Norway. Stroke 2009; 40:1958.
  16. Kim CK, Kim BJ, Ryu WS, et al. Impact of smoking cessation on the risk of subarachnoid haemorrhage: a nationwide multicentre case control study. J Neurol Neurosurg Psychiatry 2012; 83:1100.
  17. Lindekleiv H, Sandvei MS, Romundstad PR, et al. Joint effect of modifiable risk factors on the risk of aneurysmal subarachnoid hemorrhage: a cohort study. Stroke 2012; 43:1885.
  18. Lindekleiv H, Sandvei MS, Njølstad I, et al. Sex differences in risk factors for aneurysmal subarachnoid hemorrhage: a cohort study. Neurology 2011; 76:637.
  19. Woo D, Haverbusch M, Sekar P, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke 2004; 35:1703.
  20. Inagawa T. Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan. J Neurosurg 2005; 102:60.
  21. Korja M, Silventoinen K, McCarron P, et al. Genetic epidemiology of spontaneous subarachnoid hemorrhage: Nordic Twin Study. Stroke 2010; 41:2458.
  22. Okamoto K, Horisawa R, Kawamura T, et al. Family history and risk of subarachnoid hemorrhage: a case-control study in Nagoya, Japan. Stroke 2003; 34:422.
  23. van der Jagt M, Hasan D, Bijvoet HW, et al. Validity of prediction of the site of ruptured intracranial aneurysms with CT. Neurology 1999; 52:34.
  24. Broderick JP, Brown RD Jr, Sauerbeck L, et al. Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke 2009; 40:1952.
  25. Onda H, Kasuya H, Yoneyama T, et al. Genomewide-linkage and haplotype-association studies map intracranial aneurysm to chromosome 7q11. Am J Hum Genet 2001; 69:804.
  26. Farnham JM, Camp NJ, Neuhausen SL, et al. Confirmation of chromosome 7q11 locus for predisposition to intracranial aneurysm. Hum Genet 2004; 114:250.
  27. Ruigrok YM, Seitz U, Wolterink S, et al. Association of polymorphisms and haplotypes in the elastin gene in Dutch patients with sporadic aneurysmal subarachnoid hemorrhage. Stroke 2004; 35:2064.
  28. Nahed BV, Seker A, Guclu B, et al. Mapping a Mendelian form of intracranial aneurysm to 1p34.3-p36.13. Am J Hum Genet 2005; 76:172.
  29. Roos YB, Pals G, Struycken PM, et al. Genome-wide linkage in a large Dutch consanguineous family maps a locus for intracranial aneurysms to chromosome 2p13. Stroke 2004; 35:2276.
  30. Olsson S, Csajbok LZ, Jood K, et al. Association between genetic variation on chromosome 9p21 and aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2011; 82:384.
  31. Ozturk AK, Nahed BV, Bydon M, et al. Molecular genetic analysis of two large kindreds with intracranial aneurysms demonstrates linkage to 11q24-25 and 14q23-31. Stroke 2006; 37:1021.
  32. Olson JM, Vongpunsawad S, Kuivaniemi H, et al. Search for intracranial aneurysm susceptibility gene(s) using Finnish families. BMC Med Genet 2002; 3:7.
  33. van der Voet M, Olson JM, Kuivaniemi H, et al. Intracranial aneurysms in Finnish families: confirmation of linkage and refinement of the interval to chromosome 19q13.3. Am J Hum Genet 2004; 74:564.
  34. Yamada S, Utsunomiya M, Inoue K, et al. Genome-wide scan for Japanese familial intracranial aneurysms: linkage to several chromosomal regions. Circulation 2004; 110:3727.
  35. Iniesta JA, González-Conejero R, Piqueras C, et al. Platelet GP IIIa polymorphism HPA-1 (PlA) protects against subarachnoid hemorrhage. Stroke 2004; 35:2282.
  36. Foroud T, Koller DL, Lai D, et al. Genome-wide association study of intracranial aneurysms confirms role of Anril and SOX17 in disease risk. Stroke 2012; 43:2846.
  37. Schievink WI, Schaid DJ, Rogers HM, et al. On the inheritance of intracranial aneurysms. Stroke 1994; 25:2028.
  38. Bromberg JE, Rinkel GJ, Algra A, et al. Familial subarachnoid hemorrhage: distinctive features and patterns of inheritance. Ann Neurol 1995; 38:929.
  39. Ruigrok YM, Rinkel GJ, Wijmenga C, Van Gijn J. Anticipation and phenotype in familial intracranial aneurysms. J Neurol Neurosurg Psychiatry 2004; 75:1436.
  40. Leppälä JM, Paunio M, Virtamo J, et al. Alcohol consumption and stroke incidence in male smokers. Circulation 1999; 100:1209.
  41. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343:1826.
  42. Yoon BW, Bae HJ, Hong KS, et al. Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke. Neurology 2007; 68:146.
  43. Lee SM, Choi NK, Lee BC, et al. Caffeine-containing medicines increase the risk of hemorrhagic stroke. Stroke 2013; 44:2139.
  44. Levine SR, Brust JC, Futrell N, et al. A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride--a review. Neurology 1991; 41:1173.
  45. Nolte KB, Brass LM, Fletterick CF. Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study. Neurology 1996; 46:1291.
  46. Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994.
  47. Ago M, Ago K, Hara K, et al. Toxicological and histopathological analysis of a patient who died nine days after a single intravenous dose of methamphetamine: a case report. Leg Med (Tokyo) 2006; 8:235.
  48. Ho EL, Josephson SA, Lee HS, Smith WS. Cerebrovascular complications of methamphetamine abuse. Neurocrit Care 2009; 10:295.
  49. Beadell NC, Thompson EM, Delashaw JB, Cetas JS. The deleterious effects of methamphetamine use on initial presentation and clinical outcomes in aneurysmal subarachnoid hemorrhage. J Neurosurg 2012; 117:781.
  50. Chang TR, Kowalski RG, Caserta F, et al. Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage. Stroke 2013; 44:1825.
  51. Longstreth WT, Nelson LM, Koepsell TD, van Belle G. Subarachnoid hemorrhage and hormonal factors in women. A population-based case-control study. Ann Intern Med 1994; 121:168.
  52. Mhurchu CN, Anderson C, Jamrozik K, et al. Hormonal factors and risk of aneurysmal subarachnoid hemorrhage: an international population-based, case-control study. Stroke 2001; 32:606.
  53. Algra AM, Klijn CJ, Helmerhorst FM, et al. Female risk factors for subarachnoid hemorrhage: a systematic review. Neurology 2012; 79:1230.
  54. Jung SY, Bae HJ, Park BJ, et al. Parity and risk of hemorrhagic strokes. Neurology 2010; 74:1424.
  55. Schmidt M, Johansen MB, Lash TL, et al. Antiplatelet drugs and risk of subarachnoid hemorrhage: a population-based case-control study. J Thromb Haemost 2010; 8:1468.
  56. Risselada R, Straatman H, van Kooten F, et al. Withdrawal of statins and risk of subarachnoid hemorrhage. Stroke 2009; 40:2887.
  57. STEHBENS WE. ANEURYSMS AND ANATOMICAL VARIATION OF CEREBRAL ARTERIES. Arch Pathol 1963; 75:45.
  58. Sandvei MS, Mathiesen EB, Vatten LJ, et al. Incidence and mortality of aneurysmal subarachnoid hemorrhage in two Norwegian cohorts, 1984-2007. Neurology 2011; 77:1833.
  59. Schievink WI, Karemaker JM, Hageman LM, van der Werf DJ. Circumstances surrounding aneurysmal subarachnoid hemorrhage. Surg Neurol 1989; 32:266.
  60. Anderson C, Ni Mhurchu C, Scott D, et al. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke 2003; 34:1771.
  61. Vlak MH, Rinkel GJ, Greebe P, et al. Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case-crossover study. Stroke 2011; 42:1878.
  62. Shiue I, Arima H, Anderson CS, ACROSS Group. Life events and risk of subarachnoid hemorrhage: the australasian cooperative research on subarachnoid hemorrhage study (ACROSS). Stroke 2010; 41:1304.
  63. Penrose RJ. Life events before subarachnoid haemorrhage. J Psychosom Res 1972; 16:329.
  64. Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ. Prognosis of acute subdural haematoma from intracranial aneurysm rupture. J Neurol Neurosurg Psychiatry 2013; 84:254.
  65. Schuss P, Konczalla J, Platz J, et al. Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review. J Neurosurg 2013; 118:984.
  66. Douglas MR, Daniel M, Lagord C, et al. High CSF transforming growth factor beta levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus. J Neurol Neurosurg Psychiatry 2009; 80:545.
  67. Zimmermann M, Seifert V. Endothelin and subarachnoid hemorrhage: an overview. Neurosurgery 1998; 43:863.
  68. Sobey CG, Faraci FM. Subarachnoid haemorrhage: what happens to the cerebral arteries? Clin Exp Pharmacol Physiol 1998; 25:867.
  69. Dhar R, Scalfani MT, Blackburn S, et al. Relationship between angiographic vasospasm and regional hypoperfusion in aneurysmal subarachnoid hemorrhage. Stroke 2012; 43:1788.
  70. Nornes H, Magnaes B. Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 1972; 36:537.
  71. Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 1992; 76:422.
  72. Brinker T, Seifert V, Stolke D. Acute changes in the dynamics of the cerebrospinal fluid system during experimental subarachnoid hemorrhage. Neurosurgery 1990; 27:369.
  73. Heinsoo M, Eelmäe J, Kuklane M, et al. The possible role of CSF hydrodynamic parameters following in management of SAH patients. Acta Neurochir Suppl 1998; 71:13.
  74. Sakowitz OW, Santos E, Nagel A, et al. Clusters of spreading depolarizations are associated with disturbed cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage. Stroke 2013; 44:220.