CHADS_2评分预测社区非瓣膜性心房颤动患者脑卒中风险的价值

Assess the predictive value of CHADS_2 score that estimate stroke risk in patients with nonvalvular atrial fibrillation in the community

目的旨在评价脑卒中一级预防风险评估方法（CHADS2评分）对社区非瓣膜性心房颤动（简称房颤）患者缺血性脑卒中的预测价值。方法采用前瞻性队列研究方法,以在2006-2007年度参加开滦（集团）有限责任公司职工健康体检经12导联心电图证实为房颤、心房扑动（简称房扑）者为观察对象。对所有患者进行问卷调查、体格检查、实验室检测,每两年体检一次。每隔半年观察一次队列发生缺血性脑卒中、死亡的情况。依据CHADS2评分分为0、1、2、3、≥4分组,对其进一步进行危险分层分为低危（0分）、中危（1分）、高危（2-6分）组。依据CHADS2评分计算缺血性脑卒中的发病率。采用Cox比例风险模型比较不同CHADS2评分分组及分层间缺血性脑卒中的发病风险。结果共390例非瓣膜性房颤或房扑患者纳入最终统计分析,在平均5.1年的随访期间,共发生缺血性脑卒中139例,死亡137例。总人群缺血性脑卒中发病率为7.1/100人年。CHADS2评分为0、1、2、3、≥4的缺血性脑卒中发病率分别为（3.4、5.7、8.5、14.5、20.8）/100人年;随着CHADS2评分每增加一分,缺血性脑卒中发病风险增加1.48（1.27-1.72）倍。CHADS2评分为低危、中危、高危组缺血性脑卒中发病率分别为（3.4、5.7、12.0）/100人年;中危组和高危组发生缺血性脑卒中的校正风险比（95%CI）分别是低危组的1.56（0.88-2.77）和2.98（1.70-5.22）倍。结论 CHADS2评分能有效预测社区非瓣膜性房颤患者缺血性脑卒中风险。

Objective To assess the predictive value of CHADS2 score for ischemic stroke risk in patients with nonval- vular atrial fibrillation in the community. Methods A prospective cohort study including four hundred and thirty-eight workers of Kailuan who had participated in the 2006-2007 Kailuan health examination and diagnosed with atrial fibrillation or atrial flutter by using the 12-lead ECG in baseline. All participants underwent questionnaire assessment, clinical exami- nation, and laboratory assessment and were followed up biannually and were observed the occurrence of ischemic stroke or death every six months during the follow-up. Participants were divided into 0,1,2,3, ≥4 groups according to the CHADS2 score. To stratify the thromboembolic risk,patients with a CHADS2 score of 0 were classified as low risk,those with a score of 1, as moderate risk, those with a score of ≥ 2, as high risk. The incidence of ischemic stroke were calculated according tothe CHADS2 score. Cox proportional hazards regression was used to calculate the hazard ratios and 95% confi- dence intervals for the CHADS2 score. Results Analy- ses were confined to the remaining 390 participants with nonvalvular atrial fibrillation. During a mean follow-up of 5.1 years, a total of 139 patients occurred ischemic stroke and 137 patients died. The incidence of ischemie stroke was7.1 per 100 person-years. The ischemic stroke rate per 100 person-year increased by a factor of 1.48 （1.27-1.72） for each 1-point increase in the CHADS2 score ： 3.4 for a score of 0 ; 5.7 for 1 ; 8.5 for 2 ; 14.5 for 3 ;20.8 for ≥4. The is- chemic stroke rate of low risk（0）, moderate risk （1） and high risk group （≥2） stratified by CHADS2 score were （3.4,5.7, 12.0） per 100 person-years, respectively. The adjusted hazard ratio for ischemic stroke（95% CI） in the moderate risk and high risk group were 1.56 （0.88-2.77） and 2.98 （1.70-5.22） higher than that in the low risk group. Coclusion CHADS2 score can effectively predict the risk of ischemic stroke in patients with nonvalvular atrial fibrillation in the commu- nity.