改良的CHA_2DS_2-VASc评分对房颤患者左心房血栓的诊断价值  

Modified CHA_2DS_2-VASc score in predicting left atrial thrombus for patients with atrial fibrillation

作　　者：夏莺[1] 王红鸾[1] 郭韶梅[1] 蔡金莲[1] 王爱平[1] 汪俊[1] 殷然[2] 

机构地区：[1]江西省人民医院干部病房,南昌330006 [2]南昌大学第一附属医院心血管内科,南昌330006

出　　处：《江西医药》2016年第3期189-191,202,共4页Jiangxi Medical Journal

基　　金：2014年江西省卫计委科技计划项目;编号:700431003

摘　　要：目的探讨D-二聚体(DD)结合CHA_2DS_2-VASc评分对非瓣膜性心房颤动(NVAF)患者左心房血栓(LAT)的诊断价值。方法对临床怀疑LAT的NVAF患者205例进行回顾性分析,包括一般情况及病史、CHA_2DS_2-VASc评分、血生化检查及经食管超声心动图(TEE)检查。根据TEE检查结果分为左心房血栓形成组(LAT组)和无血栓形成组(非LAT组)。应用单因素分析及多因素logistic回归分析确立LAT形成的独立危险因素,进而改良CHA_2DS_2-VASc评分方案。绘制受试者工作曲线(ROC),比较改良前后两种不同的评分方案对NVAF患者LAT的诊断价值。结果 DD阳性、CHA_2DS_2-VASc>2分是LAT形成的独立危险因素;依据logistic回归分析结果,将DD阳性记为1分,加入CHA_2DS_2-VASc评分中,组成CHA_2DS_2-VAScDD评分方案。ROC曲线显示,CHA_2DS_2-VASc评分的曲线下面积(AUC)为0.663,最佳诊断点为2分,灵敏度为0.744,特异度为0.707;CHA_2DS_2-VASc-DD评分的AUC为0.811,最佳诊断点为3分,灵敏度为0.768,特异度为0.745。结论 DD结合CHA_2DS_2-VASc评分对NVAF患者LAT形成有更高的诊断价值。Objective To evaluate the value of D-dimer（DD） combined with CHA2DS2-VASc score in predicting left atrial thrombus（LAT） in patients with non-valvular atrial fibrillation（NVAF）. Methods A total of 205 NVAF patients suspected with LAT were evaluated with general condition,medical history,CHA2DS2-VASc scoring system,admission examination and transesophageal echocardiography（TEE） examination. LAT was detected by TEE in 40 patients（LAT group） and not detected in 165 patients（non-LAT group）. All data were subjected to univariate analysis and multivariate logistic regression analysis to establish independent risk factors for LAT formation. Based on the results of logistic regression analysis,a new CHA2DS2-VASc-DD scoring system was formed. The receiver operating characteristic curve（ROC） was used to compare the values of CHA2DS2-VASc and CHA2DS2-VASc-DD scores for predicting LAT formation in NVAF patients. Results Based on the results of logistic regression analysis,DD positive and CHA2DS2-VASc2 were independent risk factors for LAT formation. a new CHA2DS2-VASc-DD scoring system was formed by combining DD,recording DD positive as 1 point,and CHA2DS2-VASc score. ROC curve analysis showed that CHA2DS2-VASc-DD score（AUC=0.811） had better predictive value for LAT formation compared with CHA2DS2-VASc score（AUC=0.663）. Sensitivity and specificity for CHA2DS2-VASc and CHA2DS2-VASc-DD scoring system are 0.744,0.707 and 0.768,0.745 respectively. Conclusion Combining DD with CHA2DS2-VASc score has a better performance in predicting LAT in patients with NVAF.

关 键 词：心房颤动 左心房血栓 D-二聚体 CHA2DS2-VASc评分 

分 类 号：R541.75[医药卫生—心血管疾病]