两种风险评分与老年心房颤动伴慢性肾功能不全患者发生脑卒中风险的相关性

Association of R_(2(GFR))-CHA_(2)DS_(2)-VASc score and ATRIA score with risk of cerebral ischemic stroke in elderly AF patients with CKD

目的探讨R_(2(GFR))-CHA_(2)DS_(2)-VASc评分和ATRIA评分可否有助于降低老年心房颤动(AF)伴慢性肾脏病(CKD)患者的脑卒中风险。方法选取308例AF患者,依据有无CKD史分为合并CKD组265例和非CKD组43例,用R_(2(GFR))-CHA_(2)DS_(2)-VASc评分和ATRIA评分评估患者脑卒中风险,用logistic回归分析危险因素,ROC曲线分析各危险因素对患者发生脑卒中的预测价值。结果2组冠心病、高血压、缺血性脑卒中、慢性心力衰竭、R_(2(GFR))-CHA_(2)DS_(2)-VASc评分和ATRIA评分比较,有显著差异(P<0.05,P<0.01)。logistic回归分析示,ATRIA评分、冠心病、高血压、慢性心力衰竭与患者发生缺血性脑卒中相关(OR=22.334,12.437,30.759,15.054,P<0.05,P<0.01),ATRIA评分可作为发生缺血性脑卒中的预测因素(曲线下面积为0.968)。结论ATRIA评分可作为此类患者发生缺血性脑卒中的预测因素,R_(2(GFR))-CHA_(2)DS_(2)-VASc评分与患者发生缺血性脑卒中不相关。

Objective To study whether R_(2(GFR))-CHA_(2)DS_(2)-VASc score and ATRIA score can reduce the risk of cerebral ischemic stroke(CIS)in elderly AF patients with chronic kidney disease(CKD).Methods Three hundred and eight elderly AF patients were divided into AF with CKD group(n=265)and AF without CKD group(n=43).Their clinical data were recorded.The risk of CIS in two groups was assessed according to their R_(2(GFR))-CHA_(2)DS_(2)-VASc score and ATRIA score.The risk factors for CIS in two groups were analyzed by logistic regression analysis.The value of R_(2(GFR))-CHA_(2)DS_(2)-VASc score and ATRIA score in predicting CIS was analyzed by ROC curve analysis.Results Significant difference was detected in the incidence of CHD,hypertension,CIS and CHF,R_(2(GFR))-CHA_(2)DS_(2)-VASc score and ATRIA score between the two groups(P<0.05,P<0.001).Logistic regression analysis showed that ATRIA score,CHD,hypertension and CHF were associated with CIS in elderly AF patients with CKD(OR=22.334,12.437,30.759,15.054,P<0.05,P<0.01).ROC curve analysis displayed that ATRIA score could be used as a predictor of CIS.Conclusion ATRIA score can be used as a predictor of CIS while R_(2(GFR))-CHA_(2)DS_(2)-VASc score is not closely associated with CIS in elderly AF patients with CKD.