Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture.
Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture.
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DOI：
10.1161/strokeaha.111.619411
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发表时间：
2011-11
期刊：
影响因子：
8.3
通讯作者：
International Study of Unruptured Intracranial Aneurysms Investigators
中科院分区：
文献类型：
--
作者：
Hasan DM;Mahaney KB;Brown RD Jr;Meissner I;Piepgras DG;Huston J;Capuano AW;Torner JC;International Study of Unruptured Intracranial Aneurysms Investigators
慢性炎症被认为是颅内动脉瘤（IA）壁病理生理学中的重要现象。本研究旨在确定阿司匹林的使用是否影响IA破裂的发生。在一项巢式病例对照研究中，从前瞻性未治疗队列（n=1691）中选择入组未破裂颅内动脉瘤国际研究（ISUIA）的受试者。病例是在5年随访期内随后发生经证实的蛛网膜下腔出血的受试者。根据动脉瘤的部位和大小，将4个对照组与每个病例相匹配（58例，213例对照组）。在基线访谈时确定阿司匹林的使用频率。分析阿司匹林使用频率组的颅内出血风险。使用条件logistic回归进行双变量和多变量分析。观察到UIA破裂风险的保护作用趋势。每周3次-每日1次使用阿司匹林的患者出血的比值比（OR）为0.40 [95% CI=0.18-0.87，参考组=未使用阿司匹林]，“每月<1次”组患者的OR为0.80（95% CI=0.31-2.05），“>每月一次-每周2次”组患者的OR为0.87（95% CI=0.27-2.81）（p= 0.025）。在多变量风险因素分析中，与从不服用阿司匹林的患者相比，每周三次至每天服用阿司匹林的患者出血几率显著降低（校正OR=0.27，95% CI 0.11-0.67，p=0.03）。经常使用阿司匹林可能对IA破裂风险具有保护作用。需要进一步的动物模型和临床研究。
Chronic inflammation is postulated as an important phenomenon in intracranial aneurysm (IA) wall pathophysiology. This study was conducted to determine if aspirin use impacts the occurrence of IA rupture. Subjects enrolled in the International Study of Unruptured Intracranial Aneurysms (ISUIA) were selected from the prospective untreated cohort (n=1691) in a nested case-control study. Cases were subjects who subsequently suffered a proven aneurysmal SAH during a 5-year follow-up period. Four controls were matched to each case by site and size of aneurysm (58 cases, 213 controls). Frequency of aspirin use was determined at baseline interview. Aspirin frequency groups were analyzed for risk of aneurysmal hemorrhage. Bivariable and multivariable analyses were performed using conditional logistic regression. A trend of a protective effect for risk of UIA rupture was observed. Patients who used aspirin 3x weekly - daily had an odds ratio (OR) for hemorrhage of 0.40 [95% CI=0.18-0.87, reference group = no use of aspirin], patients in the “< once a month” group had an OR of 0.80 (95% CI=0.31-2.05) and patients in the “> once a month – 2x/week” group had an OR of 0.87 (95% CI=0.27-2.81) (p= 0.025). In multivariable risk factor analyses, patients who used aspirin three times weekly to daily had a significantly lower odds of hemorrhage (Adjusted OR=0.27, 95% CI 0.11-0.67, p=0.03) compared to those who never take aspirin. Frequent aspirin use may confer a protective effect for risk of IA rupture. Future investigation in animal models and clinical studies is needed.