非瓣膜性房颤患者的卒中风险评分系统比较

Comparison of Stroke Risk Scoring Systems in Patients with Non-Valvular Atrial Fibrillation

对于非瓣膜性房颤患者的卒中风险评估目前有三个评分系统,分别为CHADS2评分、CHA2DS2-VASc评分和非性别相关的CHA2DS2-VA评分。借助卒中风险评分对NVAF患者进行危险分层,可以权衡预防血栓带来的益处和抗凝治疗后增加出血风险的弊端。识别非瓣膜性房颤患者卒中风险危险人群,并对危险人群进一步分层,对临床上是否实行抗凝治疗尤为重要。对于卒中风险的评估逐步精准化,是基于对卒中的危险因素认识的深入,房颤患者卒中风险评分有利于为患者制定个体化的抗凝治疗方案。本文分别对上述三种卒中风险评分的诞生、优势与不足方面做一综述,寻找适合中国人的评分体系。

There are currently three scoring systems for stroke risk assessment in patients with nonvalvular atrial fibrillation, namely the CHADS2 score, the CHA2DS2-VASc score, and the non-sex-related CHA2DS2-VA score. Stroke risk scores are now needed for risk stratification in patients with NVAF, balancing the benefit of thromboprophylaxis against the downside of increased bleeding risk with anticoagulation. How to identify the risk population of stroke in patients with non-valvular atrial fi-brillation and how to further stratify the risk population is particularly important for the imple-mentation of anticoagulant therapy in clinical practice. The gradually accurate assessment of stroke risk is based on the in-depth understanding of the risk factors of stroke. The stroke risk score for patients with atrial fibrillation is conducive to the development of individualized anticoagulation therapy for patients. This article reviews the birth, advantages and disadvantages of the above three stroke risk scores.