腹動脈動脈瘤に対するプライマリーケアスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的レビュー
Janelle M Guirguis-Blake1,2, Tracy L Beil2, Caitlyn A Senger2
1Department of Family Medicine, University of Washington, Tacoma.
JAMA
|December 11, 2019
まとめ
腹動脈動脈瘤 (AAA) のスクリーニングは,AAAに関連する死亡および破裂を減少させます. しかし,スクリーニングは全因死亡率を改善し,長期的な生活の質の利益なしに手術率を増加させませんでした.
科学分野:
- 血管 外科
- 予防医学
- 公衆衛生
背景:
- 破裂した腹動脈動脈瘤 (AAA) は,推定81%の高い死亡率を伴う.
- 効果的なスクリーニングと治療戦略は 患者の成果を改善するために不可欠です
研究 の 目的:
- AAAスクリーニングの利益と害に関する証拠を体系的に検討する.
- 小型動脈瘤治療の有効性を評価する.
- 予防サービス・タスク・フォースの指針を提示する.
主な方法:
- ランダム化臨床試験 (RCT) とコホート研究の体系的レビューとメタ分析.
- 2018年9月までMEDLINE,PubMed,DARES,コクラン図書館で検索し,2019年7月まで監視した.
- AAAに関連した死亡率と破裂率,および全因死亡率のリスク比率.
主要な成果:
- 65歳以上の男性に対するスクリーニングの招待は,AAA関連の死亡率 (OR,0. 65) と破裂率 (OR,0. 62) を12~15年にわたって減少させた.
- 12~15年のスクリーニングと全因死亡率の利益 (RR,0. 99) は有意な関連性が見つかりませんでした.
- 長期的に生活の質を改善することなく,スクリーニングにより処置が増えた (OR,1.44).
- 小型AAA (3. 0- 5. 4cm) の治療は,監視と比較して死亡率の改善を示さなかったが,処置の増加を示した.
- 女性では小動脈瘤治療による外科合併症と術後の死亡率が高かった.
結論:
- 65歳以上の男性に対するAAAスクリーニングは,AAAに関連する死亡率と破裂率を低下させる.
- スクリーニングは全因死亡率に 利点を与えず 手術を増加させます
- 現状の証拠は,小型のAAAに対する早期の外科的治療をサポートしていません.
- 女性は小動脈瘤の治療に伴うリスクが高くなります.
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