心房颤动鉴别评分在急性缺血性脑卒中患者心房颤动筛查中的应用

Application of score for the targeting of atrial fibrillation for screening atrial fibrillation in patients with acute ischemic stroke

目的探讨心房颤动鉴别评分(STAF)评分联合B型脑钠肽前体(pro-BNP)在急性缺血性脑卒中患者心房颤动筛查中的应用价值。方法收集广西玉林市红十字会医院神经内科初次诊治的166例急性缺血性脑卒中患者的临床资料,根据有无心房颤动分为心房颤动组和非心房颤动组,比较两组患者的基本临床特征;以是否诊断为心房颤动为因变量,以年龄、TC、LDL-C、UA、STAF评分、心力衰竭高风险为自变量进行Logistic回归分析;并绘制STAF评分、STAF评分联合心力衰竭高风险对心房颤动的诊断效能的ROC曲线。结果心房颤动组的年龄、总胆固醇、低密度脂蛋白、尿酸、STAF评分、心力衰竭高风险患者比例均明显高于非心房颤动组,差异有统计学意义(均P <0.05)。Logistic回归分析结果显示STAF评分[OR(95%CI)=2.000(1.441~2.763)]、心力衰竭高风险[OR(95%CI)=24.793(7.822~78.634)]、年龄[OR(95%CI)=1.062(1.013~1.111)]、TC[OR(95%CI)=1.324(1.091~1.592)]与心房颤动的诊断独立相关(均P <0.05)。STAF评分诊断急性缺血性脑卒中患者心房颤动的ROC曲线下面积为0.786[95%CI(0.721,0.863),P <0.01],STAF评分最佳界值点为4.500分,相应的敏感度为85.696%,特异度为68.501%;STAF评分联合pro-BNP判断心力衰竭高风险诊断心房颤动的ROC曲线下面积为0.887[95%CI(0.842,0.944),P <0.01],患者评分最佳界值点为5.500分,相应的敏感度为85.701%,特异度为73.597%。结论 STAF评分对急性缺血性脑卒中患者的心房颤动筛查具有诊断价值,联合pro-BNP可提高诊断特异度。

Objective To evaluate the diagnostic value of score for the targeting of atrial fibrillation(STAF) for screening atrial fibrillation in patients with acute ischemic stroke. Methods The clinical data of 166 patients initially confirmed with ischemic stroke, hospitalized in the neurological department of the red cross hospital of Yulin was retrospective analyzed. The patients were divided into atrial fibrillation(AF) group and non-AF group according to whether having AF. Clinical characteristics of patients in the two groups were compared. Logistic regression analysis was performed by taking AF as the dependent variable, and age, total cholesterol(TC), low density lipoprotein cholesterin(LDL-C), uric acid(UA), STAF and high risk of heart failure as the independent variables.Receiver operating characteristic(ROC) curves were drawn to evaluate the diagnostic efficiency of STAF and STAF combined with prohormone of B-type natriuretic peptide(pro-BNP) to AF. Results Compared with non-AF group, age, TC, LDL-C, UA, STAF and the ratio of high risk of heart failure in AF group were significantly increased(all P < 0.05). Logistic regression analysis indicated that STAF[OR(95%CI)=2.000(1.441~2.763)], high risk of heart failure[OR(95%CI)=24.793(7.822~78.634)], age[OR(95%CI)=1.062(1.013~1.111)] and TC[OR(95%CI)=1.324(1.091~1.592)] were independently associated with the diagnosis of AF(all P < 0.05). The area under the ROC curve of STAF score to screen AF was 0.786[95%CI(0.721, 0.863), P < 0.01]. The optimal cutoff value was 4.500 and the sensitivity and specificity were 85.696% and 68.501% respectively. The area under the ROC curve of STAF score combined with pro-BNP to screen AF was0.887[95%CI(0.842,0.944), P < 0.01]. The optimal cutoff value was 5.500 and the sensitivity and specificity were 85.701% and 73.597% respectively. Conclusion STAF is useful in diagnosing AF in patients with acute ischemic stroke,combining with pro-BNP may improve the specificity of diagnosis.