Ashton H A, Buxton M J, Day N E, Kim L G, Marteau T M, Scott R A P, Thompson S G, Walker N M
John Radcliffe Hospital, Oxford.
Lancet. 2002 Nov 16;360(9345):1531-9. doi: 10.1016/s0140-6736(02)11522-4.
Opposing views have been published on the importance of ultrasound screening for abdominal aortic aneurysms. The Multicentre Aneurysm Screening Study was designed to assess whether or not such screening is beneficial.
A population-based sample of men (n=67800) aged 65-74 years was enrolled, and each individual randomly allocated to either receive an invitation for an abdominal ultrasound scan (invited group, n=33839) or not (control group, n=33961). Men in whom abdominal aortic aneurysms (> or =3 cm in diameter) were detected were followed-up with repeat ultrasound scans for a mean of 4.1 years. Surgery was considered on specific criteria (diameter > or =5.5 cm, expansion > or =1 cm per year, symptoms). Mortality data were obtained from the Office of National Statistics, and an intention-to-treat analysis was based on cause of death. Quality of life was assessed with four standardised scales. The primary outcome measure was mortality related to abdominal aortic aneurysm.
27147 of 33839 (80%) men in the invited group accepted the invitation to screening, and 1333 aneurysms were detected. There were 65 aneurysm-related deaths (absolute risk 0.19%) in the invited group, and 113 (0.33%) in the control group (risk reduction 42%, 95% CI 22-58; p=0.0002), with a 53% reduction (95% CI 30-64) in those who attended screening. 30-day mortality was 6% (24 of 414) after elective surgery for an aneurysm, and 37% (30 of 81) after emergency surgery.
Our results provide reliable evidence of benefit from screening for abdominal aortic aneurysms.
关于超声筛查腹主动脉瘤的重要性已发表了不同观点。多中心动脉瘤筛查研究旨在评估这种筛查是否有益。
纳入了基于人群的65 - 74岁男性样本（n = 67800），每个个体随机分配接受腹部超声扫描邀请（受邀组，n = 33839）或不接受（对照组，n = 33961）。检测出腹主动脉瘤（直径≥3 cm）的男性接受平均4.1年的重复超声扫描随访。根据特定标准（直径≥5.5 cm、每年扩张≥1 cm、出现症状）考虑手术。从国家统计局获取死亡率数据，并基于死亡原因进行意向性分析。用四个标准化量表评估生活质量。主要结局指标是与腹主动脉瘤相关的死亡率。
受邀组33839名男性中有27147名（80%）接受了筛查邀请，检测出1333例动脉瘤。受邀组有65例动脉瘤相关死亡（绝对风险0.19%），对照组有113例（0.33%）（风险降低42%，95%可信区间22 - 58；p = 0.0002），参加筛查者风险降低53%（95%可信区间30 - 64）。择期动脉瘤手术后30天死亡率为6%（414例中的24例），急诊手术后为37%（81例中的30例）。
我们的结果为腹主动脉瘤筛查的益处提供了可靠证据。
