CHA2DS2-VASc评分对非瓣膜性心房颤动患者缺血性脑卒中的预测价值  

The predictive value of CHA2DS2-VASc score for ischemic stroke in patients with nonvalvular atrial fibrillation

作　　者：刘丽云 邢彦麟 王子健 甘丰[1] LIU Liyun;XING Yanlin;WANG Zijian;GAN Feng(Department of Cardiology,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院心内科,100076

出　　处：《心肺血管病杂志》2023年第9期910-915,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心房颤动卒中风险新评分与治疗新技术研究(2021-I2M-1-063)。

摘　　要：目的:探讨LAD及NT-proBNP联合CHA2DS2-VASc评分系统[congestive heart failure,hypertension,age>75(doubled),diabetes,stroke(doubled),vascular disease,age 65-74,and sex category(female),CHA2DS2-VASc]对非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者发生缺血性脑卒中的预测价值。方法:选取北京航天总医院2010年1月至2012年1月,住院的NVAF患者989例,进行10年随访,按是否发生缺血性脑卒中分为卒中组(226例)和非卒中组(763例),比较两组临床指标的差异,并采用Cox风险比例回归模型分析NVAF患者发生缺血性脑卒中的危险因素,采用受试者工作特征曲线(ROC)评价CHA2DS2-VASc评分及CHA2DS2-VASc+LAD+NT-proBNP评分对NVAF患者发生缺血性脑卒中预测价值。结果:与非卒中组比较,卒中组患者年龄、CHA2DS2-VASc评分、LAD、NT-proBNP均显著增加,服用华法林比例显著降低(P<0.05)。剔除服用华法林患者后,应用Cox比例风险模型回归分析结果显示:年龄(OR=1.019,95%CI:1.002~1.036,P<0.05)、CHA2DS2-VASc评分(OR=1.152,95%CI:1.054~1.259,P<0.05)、LAD(OR=1.002,95%CI:0.997~1.006,P<0.05)及NT-proBNP(OR=1.000,95%CI:1.000~1.000,P<0.05)均为NVAF患者发生缺血性卒中的危险因素。CHA2DS2VASc+LAD+NT-proBNP评分及CHA2DS2-VASc评分预测缺血性卒中的AUC分别为0.668及0.618(P<0.05),CHA2DS2-VASc+LAD+NT-proBNP评分下的AUC增加0.050。CHA2DS2-VASc+LAD+NT-proBNP评分预测卒中的敏感性是58%,特异性是71%,CHA2DS2-VASc评分预测卒中的敏感性是64.6%,特异性是53.6%。结论:CHA2DS2-VASc+LAD+NT-proBNP评分可提高对NVAF患者发生缺血性脑卒中的预测价值。Objective:To investigate the predictive value of LAD and NT-proBNP combined with CHA2DS2-VASc scoring system[congestive heart failure,hypertension,age>75(doubled),diabetes,stroke(doubled),vascular disease,age 65-74,and sex category(female),CHA2DS2-VASc]for ischemic stroke in patients with non-valvular atrial fibrillation(NVAF).Methods:A total of 989 patients with NVAF who were continuously hospitalized from January 2010 to January 2012 in Beijing Aerospace General Hospital were selected and followed up for 10 years, and they were divided into stroke group (226 cases) and non-stroke group (763 cases) according to whether ischemic stroke occurred, the differences in clinical indicators between the two groups were compared, and the Cox risk proportional regression model was used to analyze the independent risk factors for ischemic stroke in NVAF patients, and the subjects' working characteristic curve (ROC) was used To assess the predictive value of CHA2DS2-VASc score and CHA2DS2- VASc+LAD+NT-proBNP score for ischemic stroke in patients with NVAF. Results: Compared with the non-stroke group, the age, CHA2DS2-VASc, LAD and NT-proBNP of the stroke group were significantly increased, the proportion of taking warfarin decreased(P<0.05). Excluding patients taking warfarin, the regression analysis of Cox proportional hazards model showed that age (OR=1.019, 95%CI: 1.002-1.036, P<0.05), CHA2DS2-VASc score (OR=1.152, 95%CI: 1.054-1.259, P<0.05), LAD (OR=1.002, 95%CI: 0.997- 1.006, P<0.05) and NT-proBNP (OR=1.000, 95%CI: 1.000-1.000, P<0.05) all are risk factors for ischemic stroke in patients with NVAF. The AUC of CHA2DS2-VASc+LAD+NT-proBNP score and CHA2DS2-VASc score for predicting ischemic stroke was 0.668 and 0.618(P<0.05), AUC increased by 0.050 under CHA2DS2- VASc+LAD+NT-proBNP score. The CHA2DS2-VASc+LAD+NT-proBNP score predicted stroke sensitivity of 58% and specificity of 71%, and the CHA2DS2-VASc score predicted stroke sensitivity of 64.6% and specificity of 53.6%. Conclusions: The CHA2DS2-VASc+LAD+NT-proBNP score

关 键 词：非瓣膜性心房颤动 脑卒中 CHA2DS2-VASc评分 左心房内径 N末端B型利钠肽前体 

分 类 号：R54[医药卫生—心血管疾病]