血液生物标志物联合CHA2DS2-VASc评分对非瓣膜性心房颤动患者发生急性脑梗死的预测价值

Predictive value of blood biomarkers combined with CHA2DS2-VASc score for acute cerebral embolism in patients with non-valvular atrial fibrillation

目的探寻非瓣膜性心房颤动(简称房颤)患者相关血液生物标志物联合CHA2DS2-VASc评分对其发生急性脑梗死的预测价值。方法选择2016年1月1日至2018年10月31日于西安交通大学第一附属医院就诊的447例非瓣膜性房颤患者,其中237例合并急性脑梗死患者作为观察组,210例单纯非瓣膜性房颤(无脑梗死病史)患者作为对照组,收集两组患者的一般资料、CHA2DS2-VASc评分及血液相关生物标志物,寻找非瓣膜性房颤患者发生急性脑梗死的血液相关危险因素,并联合CHA2DS2-VASc评分对其发生急性脑梗死的风险进行评估。结果中性粒细胞百分比、中性粒细胞/淋巴细胞比值、C反应蛋白、D-二聚体为非瓣膜性房颤患者发生急性脑梗死的危险因素(OR值分别为1.038、1.109、1.186、1.093,P<0.05);将中性粒细胞百分比、中性粒细胞/淋巴细胞比值、C反应蛋白、D-二聚体与CHA2DS2-VASc评分联合可提高对非瓣膜性房颤患者发生急性脑梗死风险的预测价值,与CHA2DS2-VASc评分相比,联合指标ROC曲线下面积增加0.095(P<0.05)。结论将中性粒细胞百分比、中性粒细胞/淋巴细胞比值、C反应蛋白、D-二聚体与CHA2DS2-VASc评分联合可提高对非瓣膜性房颤患者发生急性脑梗死风险的预测价值。

Objective To find the predictive value of blood biomarkers for acute cerebral embolism in patients with non-valvular atrial fibrillation(NVAF) and to evaluate the predictive value of those blood biomarkers on the risk of acute cerebral embolism in patients with NVAF when they were associated with CHA2DS2-VASc scores. Method 447 inpatients with NVAF from the First Affiliated Hospital of Xi’an Jiaotong University from January 1, 2016 to October 31, 2018 were selected, who were divided into NVAF with acute stroke group(n=237) and NVAF with non-acute stroke group(n=210). To compare their basic information, clinical data, and to identify blood biomarkers for acute cerebral embolism in patients with NVAF, as well as, the predictive value of related blood biomarkers combined with CHA2DS2-VASc score for risk of acute stroke in patients with NVAF. Result Percentage of neutrophils(NEUT%), neutrophil/lymphocyte(NLR), C-reactive protein(CRP), and D-dimer are risk factors for acute cerebral embolism in patients with NVAF, with OR for 1.038, 1.109, 1.186, 1.093(P<0.05);NEUT%, NLR, CRP, D-dimer combined with CHA2DS2-VASc score may increase the predictive value of acute cerebral embolism in patients with non-valvular atrial fibrillation, compared with the CHA2DS2-VASc score, the area under the ROC curve of the combined index increased by 0.095, P<0.05. Conclusion The combination of NEUT%, NLR, CRP, D-dimer with CHA2DS2-VASc score may increase the predictive value of CHA2DS2-VASc score on acute cerebral embolism in patients with non-valvular atrial fibrillation.