对腹主动脉瘤死亡率筛查的影响:人群随机对照试验

作     者：Norman P.E. Jamrozik K. Lawrence-Brown M. M. 王亭忠 

作者机构：School of Surgery and Pathology University of Western Australia Fremantle Hospital PO Box 480 Fremantle WA 6959 Australia Prof. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第4期

页      面：16-16页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：腹主动脉瘤 随机对照试验 选择性手术 流行率 干预组 西澳大利亚 

摘      要：Objective: To assess whether screening for abdominal aortic aneurysms in men r educes mortality. Design: Population based randomised controlled trial of ultras ound screening, with intention to treat analysis of age standardised mortality. Setting: Community based screening programme in Western Australia. Participants: 41 000 men aged 65-83 years randomised to intervention and control groups. Int ervention: Invitation to ultrasound screening. Main outcome measure: Deaths from abdominal aortic aneurysm in the five years after the start of screening. Resul ts: The corrected response to invitation to screening was 70%. The crude preval ence was 7.2%for aortic diameter ≥.30 mm and 0.5%for diameter ≥.55 mm. Twice as many men in the intervention group than in the control group underwent elect ive surgery for abdominal aortic aneurysm(107 v 54, P=0.002, χ2 test). Between scheduled screening and the end of follow up 18 men in the intervention group an d 25 in the control group died from abdominal aortic aneurysm, yielding a mortal ity ratio of 0.61(95%confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.1 9(0.04 to 0.89). Conclusions: At a whole population level screening for abdomina l aortic aneurysms was not effective in men aged 65-83 years and did not reduce overall death rates. The success of screening depends on choice of target age g roup and the exclusion of ineligible men. It is also important to assess the cur rent rate of elective surgery for abdominal aortic aneurysm as in some communiti es this may already approach a level that reduces the potential benefit of popul ation based screening.