CHADS2与CHA2DS2-VASc评分预测房颤卒中患者颅内外大动脉粥样硬化狭窄

Predicting Large Atherosclerotic Stenosis with CHADS2 and CHA2DS2-VASc Scores in Stroke Patients with Atrial Fibrillation

摘要: 目的：探讨CHADS2与CHA2DS2-VASc评分及评分项目预测非瓣膜性房颤并发急性缺血性卒中患者(房颤卒中)合并颅内外大动脉粥样硬化狭窄的可能性。方法：选择2018年1月至2020年1月住院治疗的非瓣膜性房颤合并急性缺血性卒中患者，根据是否存在颅内外大动脉粥样硬化狭窄标准分组，按照CHADS2评分与CHA2DS2-VASc评分项目统计患者入院时基线资料及相关实验室检查结果，对入组患者行CHADS2评分及CHA2DS2-VASc评分，并通过影像学评估颅脑结构及颅内外血管病变。结果：共入组202例房颤卒中患者，其中，合并颅内外大动脉粥样硬化狭窄病例137例(67.8%)。与未合并大动脉粥样硬化狭窄组相比，合并大动脉粥样硬化狭窄组年龄、血管疾病比例及CHA2DS2-VASc评分较高，心力衰竭比例较低。经Logistic回归分析，年龄与心力衰竭与是否合并大动脉粥样硬化狭窄独立相关。绘制ROC曲线，AUC值表明CHADS2评分项目[AUC = 0.705 (0.628~0.782), P < 0.001]、CHA2DS2-VASc评分[AUC = 0.724 (0.650~0.797), P < 0.05]及评分项目[AUC = 0.731 (0.655~0.806), P < 0.001]可预测房颤卒中合并颅内外大动脉粥样硬化狭窄。结论：在房颤合并卒中患者中，CHA2DS2-VASc评分及评分项目预测房颤卒中合并颅内外大动脉粥样硬化狭窄的效能更佳。

Abstract: Objective: To explore the possibility of CHADS2 and CHA2DS2-VASc scores and scoring items in predicting the possibility of non-valvular atrial fibrillation (NVAF) complicated by acute ischemic stroke (AIS) with intra/extracranial large atherosclerotic stenosis (LAS). Methods: AIS patients with NVAF who were hospitalized from January 2018 to January 2020 were enrolled, and were grouped according to the standard of intra/extracranial atherosclerosis stenosis. The baseline datas and relevant laboratory examinations were gathered. CHADS2 scores and CHA2DS2-VASc scores at admission were counted. Imaging evaluation of brain structure and intra/extracranial vascular were practiced. Results: Among the 202 AIS patients with NVAF, 137 cases (67.8%) concomitanted intra/extracranial atherosclerotic stenosis. Compared with the group of patients with intra/extracranial atherosclerotic stenosis (Group A), the age, the proportion of vascular disease and CHA2DS2-VASc score were higher in the group of patients without intra/extracranial atherosclerotic stenosis (Group B), whereas the proportion of heart failure (HF) was lower. Logistic regression analysis showed that the the age and the proportion of HF were independently related to the presence or absence of atherosclerotic stenosis. Receiver operating characteristic (ROC) curve analysis showed that CHADS2 scoring items [area under the curve (AUC) = 0.705 (0.628~0.782), P < 0.001], CHA2DS2-VASc scores [AUC = 0.705 (0.628~0.782), P < 0.001] and scoring items [AUC = 0.731 (0.655~0.806), P < 0.001] can predict atrial fibrillation stroke with intracranial and extracranial atherosclerotic stenosis. Conclusion: In AIS patients with NVAF, The CHA2DS2-VASc score and scoring items are more effective in predicting atrial fibrillation stroke combined with intra/extracranial atherosclerotic stenosis.