CHA_2DS_2-VASc评分结合左心房重构指标对非瓣膜性房颤脑卒中的预测价值  

Value of CHA_2DS_2-VASc scores combined with markers of the left atrial reconstruction in predicting the risk of stroke in patients with non-valvular atrial fibrillation

作　　者：任乃勇[1] 苏岑[1] 赵康仁[1] 靳彪[1] 钱进军[1] 夏海平[1] 张民凯 宋继东[1] 张渭芳[1] 

机构地区：[1]江苏大学第四附属医院神经内科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2017年第6期509-512,521,共5页Journal of Jiangsu University：Medicine Edition

基　　金：镇江市社会发展项目(SH2015027;SH2013089)

摘　　要：目的:探讨CHA_2DS_2-VASc评分结合左心房重构指标预测非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者发生脑卒中风险的价值。方法:共纳入216例符合入组标准的NVAF患者,并且依据病史及辅助检查计每位入选者的CHA_2DS_2-VASc评分,根据评分结果将患者分为高危组及低中危组。同时记录患者超声心动图中左房内径(LAD)及左房容积-时间曲线中左心房最大容积(LAV_(max))。依据随访结果将入选患者分为脑卒中组和非脑卒中组。结果:高危组LAD和LAV_(max)水平均显著高于低中危组(P<0.05)。以随访期内最终发生脑卒中事件为金标准,绘制ROC曲线,得出LAD及LAV_(max)曲线下面积(AUC)分别为0.890和0.891,当LAD≥39.9 mm或LAV_(max)≥40.35 m L时NVAF患者发生脑卒中的风险更高。然后形成CHA_2DS_2-VASc-LAD-LAV_(max)联合评分,经ROC曲线分析得出AUC为0.878,而单纯运用CHA_2DS_2-VASc评分的AUC为0.810。当CHA_2DS_2-VASc-LAD-LAV_(max)评分≥2分时,NVAF患者更易发生脑卒中事件。结论:CHA_2DS_2-VASc评分联合LAD及LAV_(max)对NVAF患者发生脑卒中风险有更高的预测价值。Objective: To investigate the value of CHA_2DS_2-VASc score combined with the markers of left atrial reconstruction in predicting the risk of stroke in patients with non-valvular atrial fibrillation( NVAF). Methods: A total of 216 cases of NVAF patients who met the criteria inclusion were selected,and according to CHA_2DS_2-VASc score by recording medical history and laboratory examinations,who were divided into the high-risk groups and the low-middle risk group. Echocardiography was recorded in each patient with left atrial diameter( LAD) and left atrial maximum volume( LAV_(max)) from left atrial volume index-time curve,in order to explore the left atrial reconstruction of the patient. According to the follow-up results,all patients were divided into the stroke group and the non-stroke group. Results:The levels of LAD and LAV_(max)in the high-risk group were significantly higher than those in the low-middle risk group( P < 0. 05). To follow-up the final stroke events as the gold standard,the ROC curve ofLAD and LAV_(max)drawing that the area under the curve( AUC) were 0. 890 and 0. 891. When the LAD level≥39. 9 mm or the LAV_(max)level ≥40. 35 m L,the patients with NVAF had higher risk for stroke.Then the combined score of CHA_2DS_2-VASc-LAD-LAV_(max)was formed that the AUC was 0. 878 with the ROC curve analysis,while the AUC of CHA_2DS_2-VASc score was only 0. 810. The patients with NVAF were more prone to suffer with stroke when CHA_2DS_2-VASc-LAD-LAV_(max)score was greater than 2. Conclusion: CHA_2DS_2-VASc score combined with LAD and LAV_(max) level had higher predictive value for the risk of stroke in NVAF patients.

关 键 词：非瓣膜性心房颤动 脑卒中 CHA2DS2-VASc评分 左心房内径 左心房最大容积 

分 类 号：R743[医药卫生—神经病学与精神病学]