Floriani M, Giulini S M, Bonardelli S, Portolani N, Benvenuti M, Pouchè A, Tiberio G
Department of Surgical Sciences, University of Brescia, Italy.
Angiology. 1988 Nov;39(11):967-72. doi: 10.1177/000331978803901106.
Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) symptomatic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (C1, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralateral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum analysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accuracy of the "critical auscultation" has a value therefore of 63%, with a sensitivity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chi-square). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently confirming the importance of neck auscultation, the authors conclude that the critical auscultation as commonly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients.
在一组接受评估的2000名患者中，他们大多数有脑血管供血不足的症状，其中441人有单侧或双侧颈部杂音。627处可闻及杂音的部位被分为主要几组：（A）有症状的（短暂性脑缺血发作和/或与杂音同侧的中风），（B）可能有症状的（与侧别无关的症状），（C）无症状的（C1，完全无症状的患者；C2，有与颈部杂音对侧半球相关症状的患者）。对每位患者进行了临床检查（病史、双上肢血压、不同水平的电子听诊）和无创仪器检查（连续波多普勒频谱分析）。61%的病例中，明显原发性的颈部杂音对应于颈动脉分叉处的病变（阳性预测值），而在认为颈部杂音为继发性的病例中，70%检测到分叉正常（阴性预测值）；因此，“关键听诊”的诊断准确性为63%，敏感性为84%，特异性为40%。在不同组患者（有症状或无症状）中获得的结果无显著差异（卡方检验）。尽管颈部杂音作为颈动脉狭窄或闭塞的体征仍有价值，从而证实了颈部听诊的重要性，但作者得出结论，即使在完全无症状的患者中，通常进行的关键听诊也无法足够可靠地排除颈动脉病变的存在。
