CHA2DS2-VASc评分结合左心房内径在预测非瓣膜性心房颤动患者脑卒中风险评估中的应用  

Application of CHA2DS2-VASc score combined with left atrial diameter prediction in stroke risk assessment of patients with non-valvular atrial fibrillation

作　　者：张琦 赖杰 毛雯 王春玲 Zhang Qi;Lai Jie;Mao Wen;Wang Chunling(Department of Cadre's Ward,Emergency General Hospital,Beijing 100028,China;不详)

机构地区：[1]北京市应急总医院干部医疗科,北京100028 [2]北京市应急总医院心血管内科,北京100028 [3]首都医科大学附属北京朝阳医院综合科,北京100028

出　　处：《中国循证心血管医学杂志》2020年第7期835-838,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：应急总医院医学科研发展基金(K201407)。

摘　　要：目的探讨CHA2DS2-VASc评分结合左房内径(LAD)对非瓣膜性房颤(NVAF)患者卒中风险的预测价值。方法对北京市应急总医院干部医疗科、心内科和首都医科大学附属北京市朝阳医院综合科于2012年1月至2014年12月收治的首次诊断为非瓣膜病心房颤动的患者共1216例进行同群队列研究,分为两组,一组为脑卒中组(366例),另一组为非脑卒中组(850例),收集相关资料,以缺血性脑卒中为终点事件,平均随访时间为(30±6)月,分析两组患者的CHA2DS2-VASc评分、左心房内径及二者联合在非瓣膜性房颤患者发生脑卒中风险评估中的ROC曲线下面积。结果脑卒中组患者的CHA2DS2-VASc评分(5.23±1.58分)显著高于非脑卒中组(2.96±1.52)分(P<0.01)。脑卒中组患者的左心房内径(42.39±5.79)mm与非脑卒中组(42.12±6.85)mm相比,无显著差异(P>0.05)。非瓣膜性房颤患者发生脑卒中风险评估中CHA2DS2-VASc评分、左心房内径、CHA2DS2-VASc评分+左心房内径的ROC曲线下面积分别为0.854、0.524、0.856,95%CI分别为0.83~0.88、0.49~0.56、0.83~0.88。CHA2DS2-VASc评分+LAD二者联合ROC曲线下面积较CHA2DS2-VASc评分相比无显著差异(P>0.05)。结论CHA2DS2-VASc评分对我国NVAF患者卒中风险的预测价值良好;LAD对NVAF患者卒中风险预测有诊断价值,但较CHA2DS2-VASc评分相比,诊断价值不高;CHA2DS2-VASc评分联合LAD对预测NVAF患者卒中风险价值较单独应用CHA2DS2-VASc评分无明显优势。Objective To explore the predictive value of CHA2DS2-VASc score combined with left atrial diameter(LAD)for stroke risk in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 1216 patients were diagnosed with non-valvular atrial fibrillation for the first time from January 2012 to December 2014 in the Department of Cardiology of Emergency General Hospital,Department of Cardiology of Emergency General Hospital and General Department of Beijing Chaoyang Hospital Affiliated to Capital Medical University Cohort study.The patients were divided into two groups,one for the stroke group(366 cases)and one for the nonstroke group(850 cases).Relevant data were collected,and the average follow-up time for ischemic stroke as the end event was(30±6)months.The CHA2DS2-VASc scores of the two groups of patients were analyzed,the left atrial inner diameter was compared,and the area under the ROC curve in the risk assessment of stroke in patients with non-valvular atrial fibrillation was calculated.Results The CHA2DS2-VASc score(5.23±1.58 points)in the stroke group was significantly higher than that in the non-stroke group(2.96±1.52 points)(P<0.01).Compared with the non-stroke group(42.12±6.85 mm),the left atrial inner diameter of the stroke group(42.39±5.79 mm)was not significantly different(P>0.05).The area under the ROC curve of CHA2DS2-VASc score,left atrium inner diameter,CHA2DS2-VASc score+left atrium inner diameter in non-valvular atrial fibrillation risk assessment was[0.854(95%CI:0.83~0.88)],[0.524(95%CI:0.49~0.56)],[0.856(95%CI:0.83~0.88)].The area under the ROC curve of the CHA2DS2-VASc score+LAD combined with the two was not significantly different from the CHA2DS2-VASc score(P>0.05).Conclusion The CHA2DS2-VASc score has a good predictive value for stroke risk of NVAF patients in my country.LAD has diagnostic value in predicting stroke risk in patients with NVAF,but it is not as valuable as CHA2DS2-VASc score.CHA2DS2-VASc score combined with LAD has no obvious advantage in predicting the risk val

关 键 词：CHA2DS2-VASc评分 非瓣膜病心房颤动 左房内径 脑卒中、风险评估 

分 类 号：R541.75[医药卫生—心血管疾病]