CHADS_2与CHA_2DS_2-VASc评分对非瓣膜病房颤患者左房血栓的风险评估  

CHADS_2 versus CHA_2DS_2- VASc scoring systems for predicting left atrial thrombus in patients with nonvalvular atrial fibrillation

作　　者：顾俊[1] 贾锋鹏[1] 封盼攀[1] 

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016

出　　处：《南方医科大学学报》2014年第11期1601-1605,共5页Journal of Southern Medical University

基　　金：国家临床重点专科建设项目(财社[2011]170号)~~

摘　　要：目的评价CHADS2评分以及CHA2DS2-VASc评分与非瓣膜病房颤患者左房血栓的相关性,并比较两种评估系统评估结果的不同。方法入选397例非瓣膜病房颤患者,分别行CHADS2评分以及CHA2DS2-VASc评分评估其血栓事件风险,比较两种评估系统平均得分及危险分层的差异;并行经食道心脏超声检查了解左房血栓的发生率,分析两种评估系统不同评分与左房血栓的相关性。结果 CHA2DS2-VASc平均得分显著高于CHADS2平均得分(1.37±1.19 vs 0.63±0.78,P<0.001),CHA2DS2-VASc评分高危组比例显著高于CHADS2评分(P<0.001),而低危组比例显著低于CHADS2评分(P<0.001)。经食道超声检查发现左房血栓共44例,分析显示左房血栓发生率随CHADS2评分以及CHA2DS2-VASc评分危险分层增高而增加,不同得分组间有明显差异(P<0.05)。单变量分析显示女性、年龄≥65岁、左房内径≥38 mm、左室射血分数≤40%、高血压、糖尿病、冠心病、脑卒中、CHADS2≥2分、CHA2DS2-VASc≥2分均和左房血栓有明显关系,但多变量logistic回归分析显示,仅CHA2DS2-VASc≥2分是唯一预测左房血栓的指标(OR:9.85,95%CI:2.178-44.542,P<0.01)。结论 CHA2DS2-VASc评估得分高于CHADS2评分,其具有优于CHADS2评分的左房血栓预测能力。Objective To assess the correlation of CHADS2 and CHA2DS2-VASc scores for left atrial thrombus in patients with nonvalvular atrial fibrillation and the differences in the results between the two scoring systems. Methods A total of 397 patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS2 and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared.The correlation of CHADS2 and CHA2DS2-VASc scores with left atrial thrombus was analyzed. Results The average score of CHA2DS2-VASc was significantly higher than that of CHADS2 in these patients（1.37±1.19 vs 0.63±0.78, P〈0.001）. The proportion of high-risk group was significantly higher（P〈0.001） while that of low-risk group significantly lower as stratified by CHA2DS2-VASc scores than by CHADS2scores（P〈0.001）. Transesophageal echocardiography detected left atrial thrombus in 44 of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS2 or CHA2DS2-VASc scores（P〈0.05）. Univariate analysis showed that female gender, age ≥65 years, left atrium diameter ≥38 mm,left ventricular ejection fraction ≤40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS2≥2, and CHA2DS2- VASc≥2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only CHA2DS2-VASc ≥2 as the independent risk factor for left atrial thrombus（OR=9.85, 95%CI： 2.178-44.542, P〈0.01）. Conclusion The average score of CHA2DS2-VASc is higher than that of CHADS2 and has better predictive ability for left atrial thrombus.

关 键 词：心房颤动 左房血栓 CHADS2评分 CHA2DS2-VASc评分 

分 类 号：R541.75[医药卫生—心血管疾病]