左心房内径联合CHA2DS2-VASc评分对非瓣膜性房颤患者发生缺血性脑卒中的预测价值

Predictive value of left atrial diameter combined CHA2 DS2-VASc score for ischemic stroke in patients with non-valvular atrial fibrillation

目的:探讨左心房内径(LAD)联合CHA2 DS2-VASc评分系统对非瓣膜性房颤患者发生缺血性脑卒中的预测价值.方法:选择我院住院的非瓣膜性房颤患者115例,按是否合并缺血性脑卒中分为房颤组(46例)和房颤+卒中组(69例),比较两组临床指标的差异,并采用多元Logistic回归分析非瓣膜性房颤患者发生缺血性脑卒中的独立危险因素,采用受试者工作特征曲线(ROC)评价LAD联合CHA2 DS2-VASc评分的方式对非瓣膜性房颤患者发生缺血性脑卒中预测价值.结果:与房颤组比较,房颤+卒中组患者年龄、LDL-C水平、CHA2 DS2-VASc评分及LAD均显著增加(P<0.05或<0.01).多元Logistic回归分析显示,年龄、LDL-C水平、CHA2 DS2-VASc评分及LAD均为非瓣膜性房颤患者发生缺血性卒中的独立危险因素(OR=1.117~3.753,P<0.05或<0.01).LAD、CHA2DS2-VASc评分及LAD联合CHA2DS2-VASc评分预测非瓣膜性房颤患者发生缺血性脑卒中的ROC曲线下面积分别为0.753、0.864及0.897,P均=0.001,LAD联合CHA2DS2-VASc评分的预测价值最高.结论:LAD联合CHA2 DS2-VASc评分可提高非瓣膜性房颤患者发生缺血性脑卒中的预测价值.

Objective:To explore predictive value of left atrial diameter(LAD) combined CHA2DS2-VASc scoring system for ischemic stroke(IS) in patients with non-valvular atrial fibrillation(NVAF). Methods:According to complicated IS or not, a total of 115 NVAF inpatients from our hospital were divided into atrial fibrillation(AF) group(n=46) and AF+IS group(n=69), and clinical indexes were compared between two groups. Multivariate Logistic regression analysis was used to analyze independent risk factors of IS in NVAF patients, receiver operator characteristic curve(ROC) was used to assess predictive value of LAD + CHA2DS2-VASc score for IS in these patients. Results:Compared with AF group, there were significant rise in age, LDL-C level, CHA2DS2-VASc score and LAD in AF+IS group, P<0.05 or <0.01. Multivariate Logistic regression analysis indicated that age, LDL-C level, CHA2DS2-VASc score and LAD were independent risk factors for IS in NVAF patients(OR=1.117~3.753, P<0.05 or <0.01). Area under ROC curve(AUC) of single LAD, CHA2DS2-VASc score and LAD + CHA2DS2-VASc score predicting IS in NVAF patients was 0.753, 0.864 and 0.897 respectively, P=0.001 all, and LAD + CHA2DS2-VASc score possessed the highest predictive value. Conclusion:LAD + CHA2DS2-VASc score can increase predictive value for ischemic stroke in patients with non-valvular atrial fibrillation.