CHA_(2)DS_(2)-VASc评分与中国非瓣膜性心房颤动患者脑卒中发生风险相关性的Meta分析

Correlation between CHA_(2)DS_(2)-VASc Score and Stroke Risk in Chinese Patients with Non-valvular Atrial Fibrillation:a Meta-analysis

目的系统评价CHA_(2)DS_(2)-VASc评分与中国非瓣膜性心房颤动(NVAF)患者脑卒中发生风险的相关性。方法计算机检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Cochrane Library、Embase发表的CHA_(2)DS_(2)-VASc评分与中国NVAF患者脑卒中发生风险相关性的队列研究或病例对照研究,检索时限从建库至2022-03-10。提取纳入文献的资料,采用纽卡斯尔-渥太华量表(NOS)进行文献质量评价,采用Rstudio进行数据分析。结果共纳入50篇文献,包括15篇队列研究和35篇病例对照研究。队列研究共纳入105081例NVAF患者,其中4364例发生脑卒中,脑卒中发生率为4.10%;病例对照研究总样本量为17282例,其中发生脑卒中的NVAF患者4498例。Meta分析结果显示,在CHA_(2)DS_(2)-VASc评分为连续型资料的文献中,病例组CHA_(2)DS_(2)-VASc评分高于对照组〔加权均数差(WMD)=1.59,95%CI(1.34,1.83),P<0.05〕。以研究类型进行亚组分析,队列研究和病例对照研究的Meta分析结果均显示,病例组CHA_(2)DS_(2)-VASc评分高于对照组〔WMD=1.42,95%CI(1.07,1.76),P<0.05;WMD=1.65,95%CI(1.33,1.97),P<0.05〕。在CHA_(2)DS_(2)-VASc评分为分类资料的文献中,病例组CHA_(2)DS_(2)-VASc评分≥2分者占比高于对照组〔OR=3.03,95%CI(1.40,6.57),P<0.05〕。结论CHA_(2)DS_(2)-VASc评分与中国NVAF患者脑卒中的发生相关,但还需完善CHA_(2)DS_(2)-VASc评分的精确度,以提高其实用性。

Objective To systematically evaluate the correlation between CHA_(2)DS_(2)-VASc score and stroke risk in Chinese patients with non-valvular atrial fibrillation(NVAF).Methods Databases including CNKI,VIP,Wanfang Data,CBM,PubMed,Cochrane Library and Embase from inception to March 10,2022 were retrieved to search for cohort studies and case-control studies on the correlation between CHA_(2)DS_(2)-VASc score and stroke risk in Chinese patients with NVAF.The data of the included literature were extracted,the Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included literature,and Rstudio was used for data analysis.Results A total of 50 articles were included,including 15 cohort studies and 35 case-control studies.A total of 105081 NVAF patients were included in cohort studies,of which 4364 had stroke,with an incidence rate of 4.10%.The total sample size of case-control studies was 17282,of which 4498 NVAF patients had stroke.The results of meta-analysis showed that,in the literature with CHA_(2)DS_(2)-VASc score as continuous data,the CHA_(2)DS_(2)-VASc score in the case group was higher than that in the control group[weighted mean difference(WMD)=1.59,95%CI(1.34,1.83),P<0.05].Subgroup analysis was conducted according to the study type,the results of meta-analysis of the cohort studies and case-control studies both showed that,the CHA_(2)DS_(2)-VASc score in the case group was higher than that in the control group[WMD=1.42,95%CI(1.07,1.76),P<0.05;WMD=1.65,95%CI(1.33,1.97),P<0.05].In the literature with CHA_(2)DS_(2)-VASc score as categorical variable data,the proportion of CHA_(2)DS_(2)-VASc score≥2 in the case group was higher than that in the control group[OR=3.03,95%CI(1.40,6.57),P<0.05].Conclusion The CHA_(2)DS_(2)-VASc score is associated with the occurrence of stroke in Chinese patients with NVAF,but the accuracy of the CHA_(2)DS_(2)-VASc score needs to be improved to improve its practicability.