CHA2DS2-VASc评分对NVAF缺血性脑卒中患者预后的评估价值

Evaluation of CHA2DS2-VASc score for short-term prognosis of ischemic stroke caused by NVAF

关键词:  非瓣膜性房颤  缺血性脑卒中  CHA2DS2-VASc评分  预后

Key words:  NVAF  cerebral arterial thrombosis  CHA2DS-VASc score  prognosis

摘要:

目的　探讨CHA2DS2-VASc评分对非瓣膜性房颤（NVAF）缺血性脑卒中短期预后评估的应用。方法　收集2014年12月至2016年9月109例NVAF缺血性脑卒中患者的临床资料，按照CHA2DS2-VASc、NIHSS及mRS相关评分标准分别对患者进行评分，根据CHA2DS2-VASc评分不同将患者分为0～1分组，2～3分组，4～5分组和≥6分组，对各评分组的临床指标进行比较。采用mRS评定患者预后，分为预后良好组（0～2分）与预后不佳组（3～6分），分析患者3个月预后不佳的独立危险因素。绘制工作特征曲线（ROC）以评价CHA2DS2-VASc对NVAF缺血性脑卒中患者预后的评估价值。结果　CHA2DS2-VASc≥6分组在女性、合并高血压病、既往卒中/TIA史、预后不佳比例显著高于其他3组(P<0.05)。多因素Logistic回归分析显示入院时NIHSS评分为患者3个月预后不佳的独立危险因素。CHA2DS2-VASc评分与发病后3个月mRS评分呈正相关（r=0.424，P<0.05）。入院时NIHSS评分≤15分时，CHA2DS2-VASc评分越高，其预后不佳的比例越高（P<0.05），NIHSS评分>15分时差异无统计学意义。结论　CHA2DS2-VASc评分对NVAF缺血性脑卒中患者的早期预后有一定的评估价值，特别是对于入院时NIHSS评分≤15分的患者。

Abstract:

Objective　To explore the value of atrial fibrillation stroke risk score (CHA2DS2-VASc score) for short-term prognosis of the ischemic stroke patients with NVAF. Methods We collected the clinical data of 109 ischemic stroke patients with NVAF since December 2014 to September 2016. The patients were scored according to the scoring standards of CHA2DS2-VASc, NIHSS and mRS. All patients were divided into four groups according to CHA2DS2-VASc scores: 0～1, 2～3, 4～5, ≥6. The clinical indicators were compared among groups. According to mRS score, patients were divided into good prognosis group and poor prognosis group. Independent predictors for poor prognosis in three months were analyzed. The receiver operating characteristic curve (ROC) was drawn to evaluate the prognostic value of CHA2DS2-VASc in ischemic stroke patients with NVAF. Results Compared to other three groups, CHA2DS2-VASc≥6 score group had significantly higher proportion of women, complication with hypertension, previous stroke/TIA, and poor prognosis (P<0.05). Multi-factor Logistic regression analysis indicated CHA2DS2-VASc score was positively correlated with the mRS score at 3 months after onset (P<0.05). There was significant difference between CHA2DS2-VASc score and poor prognosis when the patients admission NIHSS score ≤15 points（P<0.05）. But there was no significant difference between CHA2DS2-VASc score and poor prognosis when the patients admission NIHSS score >15 points. Conclusions　CHA2DS2-VASc score may help to evaluate the early improvement and prognosis of ischemic stroke patients with NVAF, especially when the admission NIHSS score ≤15 points.