CHADS2评分和CHA2DS2VASc评分预测非瓣膜性房颤患者缺血性卒中风险的价值比较  

作　　者：金星星[1] 林海燕 高达[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院,315040

出　　处：《浙江临床医学》2018年第2期233-234,共2页Zhejiang Clinical Medical Journal

摘　　要：目的比较CHADS2评分和CHA2DS2VASc评分预测非瓣膜性房颤患者缺血性卒中风险的优劣性。方法选择神经内科住院的急性缺血性卒中合并非瓣膜性房颤的患者320例，分别计算CHADS2评分（总分0~6分）和CHA2DS2VASc评分（总分0～9分）．并根据评分分为低（0分）、中（1分）、高危（≥2分）三组，比较两种评分在相同危险组间的差异。结果320例入选患者t260q6（81．30％）未采取抗凝／抗血小板聚凝措施，45例（14．10％）平素服用阿司匹林或氯吡格雷预防卒中，15例（4．70％）平素服用华法林或新型口服抗凝药预防卒中。CHADS2评分组低危患者28例（8．80％），中危患者95例（29．71％），高危患者197例（6160％）；CHA2DS2VASc评分组低危患者6例（1．90％），中危患者24例（7．50％），高危患者290例（9060％），x^2检验提示两种评分存在显著差异（p=0．000）。一致性检验示两种方法一致性差（Kappa=0208）。结论CHA2DS2VASc评分预测非瓣膜性房颤患者缺血性卒中风险优于CHADS2评分，可以更好地指导临床方案的实施。Objective To compare CHADS2 and CHA2DS2-VASc, in terms of predicting ischemic stroke risk in patients with nonvalvular atrial fibrillation. Methods 320 patients admitted to Neurology Department for acute ischemic stroke with nonvalvular atrial fibrillation were analyzed. They were divided into low-risk group （scores=0） , moderate-risk group （scores=l） and high-risk group （scores≥2） according to CHADS2 （ Scores 0-6 ） and CHA2DS2-VASc （ Scores 0-9 ） , and two scoring systems were compared. Results Among the 320 patients, 260 patients （81.30% ） did not take any anticoagulant/antiplatelet therapy, 45 patients （ 14.10% ） took antiplatelet therapy with asprin or clopidogrel, 15 patients （ 4.70% ） took anticoagulant therapy with warfarin or new oral anticoagulants. By the use of CHADS2 score, 28 patients were categorized as low-risk group, with 95 patients categorized as moderate-risk group and 197 patients categorized as high-risk group. By the use of CHA2DS2-VASc score, 6 patients were categorized as low-risk group, with 24 patients categorized as moderate-risk group and 290 patients categorized as high-risk group. The significant difference was found in two scoring systems using chi-square test. These two scoring systems exhibited poor consistency with Kappa 0.208. Conclusion The CHA2DS2-VASc score performs better than CHADS2 score in predicting ischemic stroke and can direct the selection of appropriate therapeutic approaches better.

关 键 词：非瓣膜性房颤 缺血性卒中 CHADS2评分 CHA2DS2VASc评分 

分 类 号：R743.31[医药卫生—神经病学与精神病学]