CHADS_(2)CHA_(2)DS_(2)-VASc及R_(2)CHADS_(2)评分与伴发NAVF的急性缺血性脑卒中患者预后相关性

目的探讨CHADS_(2),CHA_(2)DS_(2)-VASc及R_(2)CHADS_(2)三种评分对伴发非瓣膜性房颤(NAVF)的急性缺血性脑卒中(ACI)患者3个月功能预后的预测价值。方法选择2016年2月至2019年1月伴发NAVF的ACI患者134例,计算每位患者入院前CHADS_(2),CHA_(2)DS_(2)-VASc及R_(2)CHADS_(2)评分,采用mRS评估患者预后,根据mRS将患者分为预后良好组(0-2分)与预后不良组(3-6分)。比较预后良好及预后不良组间临床因素的差异,分析预后不良的危险因素,采用受试者工作特征(ROC)评估三种评分预测患者预后不良的敏感性、特异性、阳性预测值、阴性预测值。结果预后不良组与预后良好组CHADS_(2),CHA_(2)DS_(2)-VASc、R_(2)CHADS_(2)、年龄、入院前NIHISS评分差异均有统计学意义(P<0.05)。多因素logistic回归分析显示入院前NIHISS评分、年龄是患者3个月预后不良的危险因素。CHADS_(2),CHAzDS_(2)-VASc及R_(2)CHADS_(2)评分预测患者预后不良的AUC分别为0.681、0674、0.709。结论对于ACI伴发NAVF患者,CHADS_(2),CHA:DS_(2)-VASc、R_(2)CHADS_(2)评分对患者3个月预后不良有预测价值,且R_(2)CHADS_(2)评分预测性能优于CHADS_(2)及CHA_(2)DS_(2)-VASc评分。

Objective CHADS_(2),CHA_(2)DSz-VASc and R_(2)CHADSz score are all used to improve stroke risk strtifcation in patients with atrial fibrillation.To explore the predictive value of the above three scores on the prognosis of patients with acute ischemic stroke(ACI)complicated with non-valvular atrial fibillation(NAVF)before admission.Methods 134 ACI patients with NAVF admitted to the stroke center of Hangzhou First People's Hospital from February 2016 to January 2019 were continuously included.The CHADS_(2),CHA_(2)DS_(2)-VASc and R_(2)CHADS_(2)scores were evaluated before admission.The prognosis of patients was evaluated by mRS,and the patients were divided into good prognosis group(0-2 scores)and poor prognosis group(3-6 scores)according to mRS.The differences of clinical factors between the groups with good prognosis and poor prognosis were compared,the risk factors of poor prognosis was analyzed,and the sensitivity,specificity,positive predictive value,negative predictive value,receiver operating characteristic(ROC),and area under ROC curve(AUC)of the three scores were evaluated.Results The CHADS_(2),CHA_(2)DS_(2)-VASc,R_(2)CHADS_(2)score,age,pre--admission NIHSS score between the poor prognosis group and the good prognosis group were statstically significant(P<0.05).Multivariate logistic regression analysis showed that NIHSS score and age before adnmission were risk factors for poor prognosis.The AUC of CHADS_(2),CHAzDS_(2)--VASc and R_(2)CHADS_(2)were 0.681,0674 and 0.709 respectively.Conclusion For ACI patients with NAVF,CHADS_(2),.CHA_(2)DS_(2)-VASc and R_(2)CHADS_(2)scores have predictive value for patients with poor prognosis at 3 months,and the predictive performance of R_(2)CHADSz scores is better than CHADSz and CHA_(2)DS_(2)-VASc scores.