CHADS_(2)和CHA2DS_(2)-VASc评分卒中与隐源性脑卒中患者功能预后的相关性研究

Correlation between CHADS_(2) and CHA2DS_(2)-VASc scores and functional outcomes in patients with cryptogenic stroke

目的 探讨房颤脑卒中风险评分(CHADS_(2))和房颤脑卒中风险综合评分(CHA2DS_(2)-VASc)评分卒中与隐源性脑卒中(cryptogenic stroke,CS)患者功能预后的相关性研究。方法 选择2021年1月至2023年10月与我院就诊的150例CS患者为研究对象,采用改良Rankin量表(modified Rankin Scale,mRS)评定患者的预后,将患者分为预后良好组(n=82)和预后不良组(n=68),比较两组患者的一般资料以及两组患者入院前的CHADS_(2)和CHA2DS_(2)-VASc评分。采用受试者工作特征(receiver operating characteristic,ROC)评估CHADS_(2)和CHA2DS_(2)-VASc评分对CS患者发生预后不良的预测价值。多因素Logistic回归分析CS患者预后不良的危险因素,建立风险评估量表并进行验证。Logistic回归模型分析CHADS_(2)和CHA2DS_(2)-VASc评分与CS患者预后不良的关系。结果 与预后良好组患者相比,预后不良组心力衰竭、卒中史患者比例、入院国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、血清肌酐(serumcreatinine,Scr)、脑钠肽(brain natriuretic peptide,BNP)、尿酸、CHADS_(2)和CHA2DS_(2)-VASc评分更高,而左心室射血分数(left ventricular ejection fraction,LVEF)水平更低(P<0.05);校正混杂因素后,CHADS_(2)、CHA2DS_(2)-VASc与CS患者预后不良呈正相关;亚组分析显示CHADS_(2)、CHA2DS_(2)-VASc较高的患者,其CHADS_(2)、CHA2DS_(2)-VASc与CS患者预后不良相关性更明显(P_(交互)=0.010、0.008);多因素Logistic回归分析显示,心力衰竭、卒中史、CHADS_(2)、CHA2DS_(2)-VASc、入院NIHSS评分、BNP水平升高、LVEF水平降低均为预后不良发生的危险因素(P<0.05);CHADS_(2)和CHA2DS_(2)-VASc评分对CS患者发生预后不良的预测效能良好。且两者联合预测预后不良,预测效能更高;选取0.5分作为预后不良的最佳预测界值,其灵敏度和特异性分别为74.75%和70.28%,≤1.5分预后不良风险为低危,2~2.5分为中危,≥3.5分为高危。使用其余100例病例对量表进行验证,灵敏度为79.32%,特异性为78.85%,阳性预测值为70.22%,阴性预测值为85.64%。结论 对于CS患者CHADS_(2)和CHA2DS_(2)-VASc评分对患者预后不良具有预测价值,且两者联合预测CS患者预后,预测效能更高。

Objective To investigate the correlation between stroke and functional prognosis of patients with cryptogenic stroke(CS) by atrial fibrillation Stroke Risk score(CHADS_(2)) and atrial fibrillation Stroke risk comprehensive score(CHA2DS_(2)-VASc).Methods 150 patients with CS who came to our hospital from January 2021 to October 2023 were selected as the study objects.The modified Rankin Scale(mRS) was used to evaluate the prognosis of the patients,and the patients were divided into good prognosis group(n=82) and poor prognosis group(n=68).General data and CHADS_(2) and CHA2DS_(2)-VASc scores before admission were compared between the two groups.Receiver operating characteristic(ROC) was used to evaluate the predictive value of CHADS_(2) and CHA2DS_(2)-VASc scores in patients with CS.The risk factors of poor prognosis in CS patients were analyzed by multivariate Logistic regression,and the risk assessment scale was established and verified.Logistic regression model was used to analyze the relationship between CHADS_(2) and CHA2DS_(2)-VASc scores and poor prognosis in CS patients.Results Compared with patients in the good prognosis group,the proportion of patients with heart failure,stroke history,admission to the National Institute of Health stroke scale(NIHSS) score,serumcreatinine(serumcreatinine,Serumcreatinine) in the poor prognosis group was higher than that in the good prognosis group.Scr),brain natriuretic peptide(BNP),uric acid,CHADS_(2) and CHA2DS_(2)-VASc scores were higher,while left ventricular ejection fraction,LVEF levels were lower(P<0.05);After adjusting for confounding factors,CHADS_(2) and CHA2DS_(2)-VASc were positively correlated with poor prognosis in CS patients.Subgroup analysis showed that patients with higher CHADS_(2) and CHA2DS_(2)-VASc were more significantly associated with poor prognosis in CS patients(P interaction =0.010,0.008).Multivariate Logistic regression analysis showed that heart failure,stroke history,CHADS_(2),CHA2DS_(2)-VASC,NIHSS score on admission,increased BNP level and decreased LVEF level were all risk factors for poor prognosis(P<0.05).CHADS_(2) and CHA2DS_(2)-VASc scores were effective in predicting poor prognosis in CS patients.And the combination of the two predicted the prognosis was poor and the prediction efficiency was higher.The sensitivity and specificity of 0.5 points were 74.75% and 70.28%,respectively,and the risk of poor prognosis was defined as low risk,2-2.5 as medium risk,and ≥3.5 as high risk.The remaining 100 cases were used to verify the scale.The sensitivity was 79.32 %,the specificity was 78.85 %,the positive predictive value was 70.22 %,and the negative predictive value was 85.64 %.Conclusion For CS patients,CHADS_(2) and CHA2DS_(2)-VASc scores have predictive value for patients with poor prognosis,and the combination of the two can predict the prognosis of CS patients with higher predictive efficacy.