房颤脑卒中风险评分可评估急性脑梗死患者rt-PA静脉溶栓治疗的预后

CHA 2DS 2-VASc score can evaluate the prognosis of patients with acute cerebral infarction treated with rt-PA intravenous thrombolysis

目的:探讨房颤脑卒中风险(CHA_(2)DS_(2)-VASc)评分对急性脑梗死(ACI)患者rt-PA静脉溶栓预后的评估价值。方法:收集收治的108例进行rt-PA静脉溶栓的ACI患者临床资料进行回顾性分析,根据CHA_(2)DS_(2)-VASc评分标准,将其分为低危组(34例)、中危组(40例)及高危组(34例);根据改良的Rankin量表(mRs)评分将其分为预后良好组(49例)及预后不良组(59例)。比较CHA_(2)DS_(2)-VASc评分低、中、高危组及mRs评分预后良好组、预后不良组的一般资料;观察CHA_(2)DS_(2)-VASc评分低、中、高危组rt-PA静脉溶栓治疗后预后情况;采用单因素分析及Logistic回归分析ACI预后的不良独立危险因素,并利用ROC曲线分析CHA_(2)DS_(2)-VASc评分对ACI预后的评估价值。结果:高危组的年龄、糖尿病、心力衰竭、卒中史的患者比例高于中危组和低危组;中危组的年龄、糖尿病、卒中史、心力衰竭的患者比例高于低危组(P均<0.05)。预后不良组年龄、卒中史、CHA_(2)DS_(2)-VASc评分指标明显高于预后良好组(P均<0.05)。高危组预后良好的患者比例少于低危组(χ^(2)=8.589,P=0.003);其他各组间比较,差异无统计学意义(P均>0.05)。Logistic回归分析发现高龄、卒中史、心力衰竭、糖尿病、CHA_(2)DS_(2)-VASc评分为ACI预后不良独立危险因素(P均<0.05)。CHA_(2)DS_(2)-VASc评分曲线下面积为0.803。结论:CHA_(2)DS_(2)-VASc评分对ACIrt-PA静脉溶栓后早期预后呈现出良好的评估价值。

Objective:To explore the value of congestive heart failure,hypertension,age≥75 years,diabetes mellitus,stroke or transient ischemic attack,vascular disease,age 65 to 74 years,sex category(CHA_(2)DS_(2)-VASc)score in evaluating the prognosis of patients with acute stroke undergoing rt-PA intravenous thrombolysis.Methods:The clinical data of 108 ACI patients who received rt-PA intravenous thrombolysis were retrospectively analyzed,and they were divided into low risk group(34 cases),medium risk group(40 cases)and high risk group(34 cases)according to CHA_(2)DS_(2)-VASC scoring standard.According to mRs score,they were divided into good prognosis group(49 cases)and poor prognosis group(59 cases).The general data of CHA_(2)DS_(2)-VASc group with low,intermediate and high risk score,and modified Rankin scale(mRs)group with good prognosis and poor prognosis were compared.The prognosis of low,medium and high risk groups of CHA_(2)DS_(2)-VASC after intravenous thrombolytic therapy with rt-PA was observed.Single factor analysis and Logistic regression analysis were used to analyze the independent risk factors of poor ACI prognosis,the ROC curve were used to analyze the value of CHA_(2)DS_(2)-VASc score in evaluating the prognosis of stroke.Results:The age was older,and the proportion of patients with diabetes,heart failure and stroke history was higher in the high-risk group than those in the intermediate-risk group and the low-risk group(all P<0.05).The age was older and the proportions of patients with diabetes,stroke history,heart failure were higher in the intermediate-risk group than those in the low-risk group(all P<0.05).The age was older,the proportions of patients with stroke history and CHA_(2)DS_(2)-VASc score index were significantly higher in the poor prognosis group than those in the good prognosis group(P<0.05).The number of cases with good prognosis in the high-risk group was significantly less than that in the low-risk group(χ^(2)=8.589,P=0.003);there was no significant difference among other groups(P>0.05).Logistic regression analysis found that age,stroke history,heart failure,diabetes,CHA_(2)DS_(2)-VASc score were all independent risk factors for poor prognosis of ACI.The area under the CHA_(2)DS_(2)-VASc score curve was 0.803.Conclusion:CHA_(2)DS_(2)-VASc score has certain value in evaluating early prognosis of acute stroke after intravenous thrombolysis with rt-PA.