【每日动态】无症状成人无须筛查颈动脉狭窄
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http://www.bmj.com/content/349/bmj.g4538
Asymptomatic adults should not be screened for carotid artery stenosis,US panel concludes
无症状患者无须筛查颈动脉狭窄
Asymptomatic adults should not be screened for carotid artery stenosis,the US Preventive Services Task Force (USPSTF) has recommended.1
根据美国预防服务工作（USPSTF）7月8日发布的建议，对于无症状成人，无须进行颈动脉狭窄的筛查。
The new recommendations applied to adults without a history oftransient ischemic attack, stroke, or other neurologic signs and symptoms andreaffirmed similar recommendations made by the task force in 2007. USPSTF makesrecommendations on the effectiveness of preventive care services for patientswithout related conditions and services. It bases its recommendations on theevidence for benefits and harms but does not consider costs.
新推荐适用于无短暂性脑脑缺血病史、卒中或其他神经系统体征和症状的成人，并且再次肯定了工作组在2007年的相似推荐。对于无相关疾病的患者，USPSTF根据预防保健服务的有效性制定相关推荐，而相关推荐的制定基于获益和有害的证据，而不是花费。
The review was funded by the US Agency for Healthcare Research andQuality. The task force’s recommendations and accompanying systematic reviewwere published in the Annals of Internal Medicine.2
此次推荐由美国卫生保健研究和质量机构资助。工作组的推荐及相关系统综述在7月8日在线发表于《内科学年鉴》。
Stroke is a leading cause of death and disability, but carotid arterystenosis—defined as a 70% (or 75%) to 99% narrowing of the lumen—is relativelyrare in the general population, with a prevalence of about 0.5% to 1.0%. As aresult of this low prevalence, screening of the general population has a highfalse positive rate, even though the standard screening test, ultrasonography,has high sensitivity and specificity, the USPSTF said.
卒中是死亡和致残的主要原因，但颈动脉狭窄（管腔狭窄70%[或75%]-99%）在普通人群的发病相对罕见，其患病率约为0.5%—1.0%。根据USPSTE的报告，由于颈动脉狭窄较低的患病率，普通人群筛查时将出现较高的假阳性率，即使用高敏感和特异的标准筛查方法—超声检查，也会如此。
Although ultrasonography itself has few direct harms, all screeningstrategies—including those with confirmatory tests, such as magnetic resonanceangiography—still have “imperfect sensitivity and specificity and could lead tounnecessary interventions and result in serious harms,” it added.
此外，USPSTF还认为，尽管超声检查本身很少有直接损害，但所有的筛查策略，包括确诊检查，如核磁共振成像，“其敏感性和特异性并非十全十美，并且有可能导致不必要的侵入性检查及严重伤害”。
Even in selected centers, the task force noted, carotid endarterectomywas associated with a 30 day stroke or mortality rate of about 2.4% and rateswere reported to be as high as 5% in low volume centers. In the case of carotidangioplasty and stenting the 30 day stroke or mortality rate was about3.1-3.8%.
工作组还指出，即使在入选的中心，颈动脉内膜切除术后30天的卒中或死亡率为2.4%，而较小的中心则可达到5%。对于颈动脉造影和支架植入，30天卒中或死亡率为3.1-3.8%%。
USPSTF said that, although clinical trials had shown that treatingcarotid artery stenosis with endarterectomy reduced the absolute incidence ofall strokes or perioperative death by about 3.5%, these trials had involvedselected patients undergoing surgery by selected surgeons, and it compared theresults with medical treatment that today would be considered outdated. “Themagnitude of these benefits would be smaller in asymptomatic persons in thegeneral population. For the general primary care population, the magnitude ofbenefit is small to none,” it said.
尽管临床试验表明，使用颈动脉内膜切除术治疗颈动脉狭窄可使绝对卒中或围手术期死亡率降低约3.5%，但这些试验的部分参与患者经过选择，手术由指定的外科医生执行，对比于现今的药物治疗也显得过时。“无症状普通人群的获益将会更小，而普通一级预防人群的获益则微乎其微”。
Because previous studies comparing surgical outcomes with medicalmanagement did not include intensive blood pressure and lipid control(currently standard practice for the prevention of cardiovascular disease),USPSTF said that it was difficult to assess what effect current medicalmanagement would have on comparative outcomes of medical and surgicaltreatment. However, it said that planned and ongoing trials should allow suchcomparisons.
由于既往外科手术与药物治疗的比较研究并未包括严格血压和血脂控制（最新的心血管疾病预防的标准事件）。USPSTF认为，与药物和外科治疗的结果相比，很难评价现有药物治疗的效果，但正在计划和实行的相关试验应进行这方面的比较。
In an accompanying editorial, Larry B Goldstein of Duke University inDurham, North Carolina, noted that carotid artery stenosis screening tests werecommonly offered at health fairs and other settings. “[P]otential consumers ofthese services should be aware that the test is unlikely to prevent them fromhaving a stroke or to lead to improvements in their health,” he wrote.3
杜克大学的Larry B Goldstein在随篇述评中写道：“颈动脉狭窄的筛查在健康博览会或其它机构中很常见，但这些检查并不能预防卒中或提高健康，相关服务的潜在消费者应予以警惕”。
Asymptomatic adults should not be screened for carotid artery stenosis,US panel concludes
无症状患者无须筛查颈动脉狭窄
Asymptomatic adults should not be screened for carotid artery stenosis,the US Preventive Services Task Force (USPSTF) has recommended.1
根据美国预防服务工作（USPSTF）7月8日发布的建议，对于无症状成人，无须进行颈动脉狭窄的筛查。
The new recommendations applied to adults without a history oftransient ischemic attack, stroke, or other neurologic signs and symptoms andreaffirmed similar recommendations made by the task force in 2007. USPSTF makesrecommendations on the effectiveness of preventive care services for patientswithout related conditions and services. It bases its recommendations on theevidence for benefits and harms but does not consider costs.
新推荐适用于无短暂性脑脑缺血病史、卒中或其他神经系统体征和症状的成人，并且再次肯定了工作组在2007年的相似推荐。对于无相关疾病的患者，USPSTF根据预防保健服务的有效性制定相关推荐，而相关推荐的制定基于获益和有害的证据，而不是花费。
The review was funded by the US Agency for Healthcare Research andQuality. The task force’s recommendations and accompanying systematic reviewwere published in the Annals of Internal Medicine.2
此次推荐由美国卫生保健研究和质量机构资助。工作组的推荐及相关系统综述在7月8日在线发表于《内科学年鉴》。
Stroke is a leading cause of death and disability, but carotid arterystenosis—defined as a 70% (or 75%) to 99% narrowing of the lumen—is relativelyrare in the general population, with a prevalence of about 0.5% to 1.0%. As aresult of this low prevalence, screening of the general population has a highfalse positive rate, even though the standard screening test, ultrasonography,has high sensitivity and specificity, the USPSTF said.
卒中是死亡和致残的主要原因，但颈动脉狭窄（管腔狭窄70%[或75%]-99%）在普通人群的发病相对罕见，其患病率约为0.5%—1.0%。根据USPSTE的报告，由于颈动脉狭窄较低的患病率，普通人群筛查时将出现较高的假阳性率，即使用高敏感和特异的标准筛查方法—超声检查，也会如此。
Although ultrasonography itself has few direct harms, all screeningstrategies—including those with confirmatory tests, such as magnetic resonanceangiography—still have “imperfect sensitivity and specificity and could lead tounnecessary interventions and result in serious harms,” it added.
此外，USPSTF还认为，尽管超声检查本身很少有直接损害，但所有的筛查策略，包括确诊检查，如核磁共振成像，“其敏感性和特异性并非十全十美，并且有可能导致不必要的侵入性检查及严重伤害”。
Even in selected centers, the task force noted, carotid endarterectomywas associated with a 30 day stroke or mortality rate of about 2.4% and rateswere reported to be as high as 5% in low volume centers. In the case of carotidangioplasty and stenting the 30 day stroke or mortality rate was about3.1-3.8%.
工作组还指出，即使在入选的中心，颈动脉内膜切除术后30天的卒中或死亡率为2.4%，而较小的中心则可达到5%。对于颈动脉造影和支架植入，30天卒中或死亡率为3.1-3.8%%。
USPSTF said that, although clinical trials had shown that treatingcarotid artery stenosis with endarterectomy reduced the absolute incidence ofall strokes or perioperative death by about 3.5%, these trials had involvedselected patients undergoing surgery by selected surgeons, and it compared theresults with medical treatment that today would be considered outdated. “Themagnitude of these benefits would be smaller in asymptomatic persons in thegeneral population. For the general primary care population, the magnitude ofbenefit is small to none,” it said.
尽管临床试验表明，使用颈动脉内膜切除术治疗颈动脉狭窄可使绝对卒中或围手术期死亡率降低约3.5%，但这些试验的部分参与患者经过选择，手术由指定的外科医生执行，对比于现今的药物治疗也显得过时。“无症状普通人群的获益将会更小，而普通一级预防人群的获益则微乎其微”。
Because previous studies comparing surgical outcomes with medicalmanagement did not include intensive blood pressure and lipid control(currently standard practice for the prevention of cardiovascular disease),USPSTF said that it was difficult to assess what effect current medicalmanagement would have on comparative outcomes of medical and surgicaltreatment. However, it said that planned and ongoing trials should allow suchcomparisons.
由于既往外科手术与药物治疗的比较研究并未包括严格血压和血脂控制（最新的心血管疾病预防的标准事件）。USPSTF认为，与药物和外科治疗的结果相比，很难评价现有药物治疗的效果，但正在计划和实行的相关试验应进行这方面的比较。
In an accompanying editorial, Larry B Goldstein of Duke University inDurham, North Carolina, noted that carotid artery stenosis screening tests werecommonly offered at health fairs and other settings. “[P]otential consumers ofthese services should be aware that the test is unlikely to prevent them fromhaving a stroke or to lead to improvements in their health,” he wrote.3
杜克大学的Larry B Goldstein在随篇述评中写道：“颈动脉狭窄的筛查在健康博览会或其它机构中很常见，但这些检查并不能预防卒中或提高健康，相关服务的潜在消费者应予以警惕”。
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