合并房颤的急性缺血性卒中患者CHADS2评分与预后的关系  

The relationship between CHADS2 score and prognosis in acute ischemic stroke patients with nonvalvular atrial fibrillation

作　　者：黄良通[1] 韩钊[1] 叶祖森[1] 景宏菲[1] 张征[1] 王贞[1] 冯靓[1] 肖美娟[1] 

机构地区：[1]浙江省温州医学院附属第一医院脑血管科,325000

出　　处：《中华神经科杂志》2012年第3期169-173,共5页Chinese Journal of Neurology

基　　金：温州市科技局资助项目（Y2004AO14）

摘　　要：目的探讨CHADS2评分与合并非瓣膜性房颤的急性缺血性卒中患者近期预后的关系。方法前瞻性纳入发病7d内合并非瓣膜性房颤的卒中患者，行发病前CHADS：评分，分3组（0～1、2、3～6分），随访住院期间并发症和3个月时预后情况[改良Rankin量表评分（mRS）≤2为预后良好，mRS≥5为预后极差]，单因素分析筛选影响3个月预后的危险因素后，再采用Logistic逐步回归分析CHADS，评分与3个月预后的关系。结果共纳入203例患者，其中CHADS：0～1、2、3～6组各72、53、78例，CHADS：评分高者入院时NIHSS评分较高，均数分别为9．8、12．6、13．0（F=3．404，P=0．035）；肺部感染发生率较高，分别为12．5％、34．0％、39．7％（Х^2=14．643，P=0．001）；预后良好率较低；预后极差率较高；多因素Logistic回归分析显示CHADS：评分是预后良好和预后极差的独立预测因子，以CHADS，3～6组为参考，CHADS：0～1预测良好预后的OR值为5．018（95％CI为2．055—12．560）；以CHADS2 0～1组为参考，CHADS2 3—6预测极差预后的OR值为6．197（95％ci为1．670～22．996）。结论发病前CHADS2评分与合并非瓣膜性房颤的缺血性卒中患者预后相关，评分低者（0—1）预后良好可能性大，评分高者（3～6）预后极差可能性大。Objective To explore the relationship between the CHADS2 score and short-term prognosis in acute isehemie stroke patients with nonvalvular atrial fibrillation. Methods Consecutive ischemic stroke patients with nonvalvular atrial fibrillation who were hospitalized within 7 days after stroke were registered. Patients were divided into 3 groups on the basis of CHADS2 pre-stroke score （0 to 1,2, 3 to 6 ）. And recovery was assessed by modified Rankin Scale （mRS） at 3 months follow-up （mRS ≤ 2 reflected good prognosis , and mRS ≥ 5 implicated unfavorable outcome）. After screening the risk factors affecting prognosis using univariate analysis, the relationship between CHADS2 score and prognosis was estimated using logistic regression model. Results Of 203 patients enrolled, the CHADS2 score of 0-1,2, 3-6 were present in 72, 53 and 78 respectively. Patients with the higher CHADS2 score bad a higher initial NIHSS score （9.8, 12.6, 13.0, F = 3. 404, P = 0. 008 ） , more likely to receive nosoeomial pulmonary infection（ 12.5% ,34.0% ,39.7%, Х^2 = 14. 643, P = 0. 001 ）, negatively related to good prognosis （ Х^2 = 28. 542, P = 0. 000 ） and positively related to unfavorable outcome （Х^2 = 23. 575, P = 0. 000 ）. Logistic regression model results suggested that CHADS2 score was an independent predictor of good prognosis and unfavorable outcome. Compared with CHADS2 score 3-6, CHADS2 score 0-1 was independently associated with good prognosis （ OR = 5. 018, 95% CI 2.055-12. 560）. And compared with CHADS2 score 0-1, CHADS2 score 3-6 was independently associated with unfavorable outcome （ OR = 6. 197, 95% CI 1. 670-22. 996 ）. Conclusions CHADS2 pre-stroke score appears to be useful in prediction of stroke outcome for patients with nonvalvular atrial fibrillation. After acute ischemic stroke, the patients with the lower CHADS2 score （0-1） are more likely to achieve good prognosis, inversely, the patients with the higher CHADS2 score （3-6） are more likely to achieve unfavorable outcom

关 键 词：脑梗死 卒中 心房颤动 抗凝药 危险因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]