颈动脉杂音与脑血管病风险：荟萃分析。
Carotid bruits and cerebrovascular disease risk: a meta-analysis.
机构信息
Keller Army Hospital, US Military Academy, West Point, NY 10996, USA.
出版信息
Stroke. 2010 Oct;41(10):2295-302. doi: 10.1161/STROKEAHA.110.585554. Epub 2010 Aug 19.
BACKGROUND AND PURPOSE
Current guidelines recommend against routine auscultation of carotid arteries, believing that carotid bruits are poor predictors of either underlying carotid stenosis or stroke risk in asymptomatic patients. We investigated whether the presence of a carotid bruit is associated with increased risk for transient ischemic attack, stroke, or death by stroke (stroke death).
METHODS
We searched Medline (1966 to December 2009) and EMBASE (1974 to December 2009) with the terms "carotid" and "bruit." Bibliographies of all retrieved articles were also searched. Articles were included if they prospectively reported the incidence of transient ischemic attack, stroke, or stroke death in asymptomatic adults. Two authors independently reviewed and extracted data.
RESULTS
We included 28 prospective cohort articles that followed a total of 17 913 patients for 67 708 patient-years. Among studies that directly compared patients with and without bruits, the rate ratio for transient ischemic attack was 4.00 (95% CI, 1.8 to 9.0, P<0.0005, n=5 studies), stroke was 2.5 (95% CI, 1.8 to 3.5, P<0.0005, n=6 studies), and stroke death was 2.7 (95% CI, 1.33 to 5.53, P=0.002, n=3 studies). Among the larger pool of studies that provided data on rates, transient ischemic attack rates were 2.6 per 100 patient-years (95% CI, 2.0 to 3.2, P<0.0005, n=24 studies) for those with bruits compared with 0.9 per 100 patient-years (95% CI, 0.2 to 1.6, P=0.02, n=5 studies) for those without carotid bruits. Stroke rates were 1.6 per 100 patient-years (95% CI, 1.3 to 1.9, P<0.0005, n=26 studies) for those with bruits compared with 1.3 per 100 patient-years (95% CI, 0.8 to 1.7, P<0.0005, n=6) without carotid bruits, and death rates were 0.32 (95% CI, 0.20 to 0.44, P<0.005, n=13 studies) for those with bruits compared with 0.35 (95% CI, 0.00 to 0.81, P=0.17, n=3 studies) for those without carotid bruits.
CONCLUSIONS
The presence of a carotid bruit may increase the risk of cerebrovascular disease.
背景与目的
目前的指南不建议常规听诊颈动脉，因为认为颈动脉杂音对无症状患者的颈动脉狭窄或中风风险预测价值较低。我们研究了颈动脉杂音的存在是否与短暂性脑缺血发作、中风或中风死亡（中风死亡）的风险增加有关。
方法
我们检索了 Medline（1966 年至 2009 年 12 月）和 EMBASE（1974 年至 2009 年 12 月），使用了“颈动脉”和“杂音”这两个术语。还对所有检索到的文章的参考文献进行了搜索。如果前瞻性报告了无症状成年人中短暂性脑缺血发作、中风或中风死亡的发生率，则将文章纳入研究。两位作者独立地进行了回顾和数据提取。
结果
我们纳入了 28 项前瞻性队列研究，共随访了 17913 例患者，随访时间为 67708 患者年。在直接比较有和无杂音的患者的研究中，短暂性脑缺血发作的发生率比为 4.00（95%CI，1.8 至 9.0，P<0.0005，n=5 项研究），中风的发生率比为 2.5（95%CI，1.8 至 3.5，P<0.0005，n=6 项研究），中风死亡的发生率比为 2.7（95%CI，1.33 至 5.53，P=0.002，n=3 项研究）。在提供了发生率数据的更大的研究池中，有杂音的患者的短暂性脑缺血发作发生率为每 100 患者年 2.6 例（95%CI，2.0 至 3.2，P<0.0005，n=24 项研究），而无颈动脉杂音的患者发生率为每 100 患者年 0.9 例（95%CI，0.2 至 1.6，P=0.02，n=5 项研究）。有杂音的患者中风发生率为每 100 患者年 1.6 例（95%CI，1.3 至 1.9，P<0.0005，n=26 项研究），而无颈动脉杂音的患者发生率为每 100 患者年 1.3 例（95%CI，0.8 至 1.7，P<0.0005，n=6 项研究），有杂音的患者死亡率为每 100 患者年 0.32 例（95%CI，0.20 至 0.44，P<0.005，n=13 项研究），而无颈动脉杂音的患者死亡率为每 100 患者年 0.35 例（95%CI，0.00 至 0.81，P=0.17，n=3 项研究）。
结论
颈动脉杂音的存在可能增加脑血管疾病的风险。
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