CHA2DS2-Vasc评分联合血清FAR在冠心病中的诊断价值

Diagnostic Value of CHA₂DS₂-Vasc Score Combined with Serum Fibrinogen-to-Albumin Ratio in Coronary Heart Disease

摘要: 目的：探讨CHA₂DS₂-Vasc评分联合血清维蛋白原和白蛋白比值(fibrinogen to albumin ratio, FAR)对冠心病(coronary heart disease, CHD)的诊断价值。方法：纳入2017/01/01~2019/01/01期间于安徽医科大学第二附属医院老年心血管内科行冠脉造影术(coronary angiography, CAG)检查的患者185例，其中明确诊断为冠心病116例，非冠心病69例。收集患者的临床资料，所有患者计算FAR值，评估CHA₂DS₂-Vasc评分。以发生冠心病为因变量，年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA₂DS₂-Vasc评分作为自变量建立logistic回归模型，采用受试者工作特征曲线(receiver operating curve, ROC)评估CHA₂DS₂-Vasc评分联合FAR对冠心病的诊断价值。结果：两组年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA₂DS₂-Vasc评分差异有统计学意义(P < 0.05)。多因素logistic回归分析显示CHA₂DS₂-Vasc评分及FAR与CHD的发生呈独立正相联(P < 0.01)。应用ROC曲线评估CHA₂DS₂-Vasc评分、FAR单项及联合诊断的效能，结果显示CHA₂DS₂-Vasc评分的曲线下面积(area under curve, AUC)为0.656 (95% CI 0.575~0.736)，P < 0.001，其敏感度60.3%，特异性63.8%，cut-off值1.5；FAR的AUC为0.602 (95% CI 0.521~0.684)，敏感度36.2%，特异性85.5%，cut-off值0.075；CHA₂DS₂-Vasc评分联合FAR的AUC为0.702 (95% CI 0.624~0.780)，敏感度79.3%，特异性52.2%，cut-off值0.552。结论：与CHA₂DS₂-Vasc评分及FAR相比，CHA₂DS₂-Vasc联合血清FAR对患者发生冠心病具有更好的临床评估价值。

Abstract: Objective: To explore the value of CHA₂DS₂-Vasc score combined with serum Fibrinogen-to-Albumin Ratio (FAR) in the diagnosis of coronary heart disease (CHD). Methods: 185 patients who underwent coronary angiography (CAG) in the Department of Geriatric Cardiology at the Second Affiliated Hos-pital of Anhui Medical University from 2017/01/01 to 2019/01/01 were included. Among them, 116 patients were diagnosed with coronary heart disease, 69 patients without coronary heart dis-ease. Clinical data were collected from patients, and all patients were calculated for FAR values to assess CHA₂DS₂-Vasc scores. A logistic regression model was established with the occurrence of cor-onary heart disease as the dependent variable, age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA₂DS₂-Vasc score as independent variables, and the receiver operating curve (ROC) was used to evaluate the diagnostic value of CHA₂DS₂-Vasc score combined with FAR for coronary heart disease. Results: There were significant differences in age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA₂DS₂-Vasc scores between the two groups (P < 0.05). Multivariate lo-gistic regression analysis showed that CHA₂DS₂-Vasc scores and the occurrence of FAR and CHD were independently positively correlated (P < 0.01). The ROC curve was used to evaluate the value of CHA₂DS₂-Vasc scores, FAR and CHA₂DS₂-Vasc-FAR score for diagnosis of CHD. The area under curve (AUC) of CHA₂DS₂-Vasc scores were 0.656 (95% CI 0.575~0.736, P < 0.001), its sensitivity was 60.3%, specificity was 63.8%, cut-off value was 1.5; The AUC of FAR was 0.602 (95% CI 0.521~0.684), sen-sitivity 36.2%, specificity 85.5%, cut-off value 0.075; The AUC of CHA₂DS₂-Vasc score combined with FAR was 0.702 (95% CI 0.624~0.780), sensitivity 79.3%, specificity 52.2%, cut-off value 0.552. Con-clusion: Compared with CHA₂DS₂-Vasc and FAR, CHA2DS2-Vasc combined with serum FAR has better clinical evaluation value for coronary heart disease in patients.