摘要
目的探讨非瓣膜性心房纤颤（NVAF）CHADS2评分低中危患者发生脑卒中的危险因素。方法选取2009年1月—2012年12月在复旦大学附属金山医院神经内科住院的NVAF合并脑卒中患者（n=98）,计算CHADS2评分及CHA2DS2-VASc评分,筛选CHADS2评分低中危（0-2分）患者为病例组（n=58）,选取同期在该院心内科住院的NVAF不合并脑卒中患者为对照组（n=53）。比较两组的临床特征、心脏超声及实验室检查结果等,脑卒中发生的影响因素分析采用多因素非条件Logistic回归分析。结果 98例NVAF合并脑卒中患者中CHADS2评分低中危患者58例（59.2%）,CHA2DS2-VASc评分（≥2分）高危患者95例（96.9%）。病例组吸烟史、心力衰竭、冠心病的发生率及丙氨酸氨基转移酶（ALT）、血肌酐（SCr）、心率水平均低于对照组;而总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、脂蛋白a〔LP（a）〕、左心室射血分数（LVEF）均高于对照组,差异有统计学意义（P〈0.05）。多因素非条件Logistic回归分析显示,心率、TC、LDL-C、吸烟史、心力衰竭、冠心病对CHADS2评分低中危患者发生脑卒中的影响有统计学意义（P〈0.05）。结论患者心率〈80次/min、高胆固醇（〉5.72 mmol/L）为CHADS2评分低中危患者发生脑卒中的独立危险因素。CHA2DS2-VASc评分系统对低中危患者的风险分层优于CHADS2评分系统。该评分系统在我国人群中运用的实际效果,还需要进一步验证和进行必要的调整。
Objective To investigate the risk factors for stroke in non- valvular atrial fibrillation（ NVAF） patients with low- intermediate CHADS2 risk score. Methods We enrolled 98 NVAF patients complicated with stroke who were admitted into the Neurology Department of Jinshan Hospital Affiliated to Fudan University from January 2009 to December 2012. CHADS2 scores and CHA2DS2- VASc scores were calculated. The subjects who had low- intermediate CHADS2 risk scores（ 0 - 2） were assigned into case group（ n = 58）,and another 53 NVAF patients without stroke who were admitted into the same department during the same period were enrolled as control group. Comparison was made between the two groups in clinical features,cardiac ultrasound results and laboratory examination results. Multivariate non- conditional logistic regression analysis was conducted to determine the influencing factors. Results Of the 98 NVAF patients complicated with stroke,58 patients（ 59. 2%） had low-intermediate CHADS2 risk score,and 95 patients（ 96. 9%） had high CHA2DS2- VASc score（ ≥2）. The case group was lower（ P〈0. 05） than the control group in smoking history,cardiac failure,the incidence of coronary heart disease,ALT,SCr and heart rate; the case group was higher（ P〈0. 05） than the control group in TC, LDL- C, LP（ a） and LVEF. Multivariate non- conditional logistic regression analysis showed that heart rate,TC,LDL- C,smoking history,cardiac failure and coronary heart disease had significant influence（ P〈0. 05） on the incidence of stroke in NVAF patients with low-intermediate CHADS2 score. Conclusion A heart rate of less than 80 / min and high cholesterol（ 〉5. 72 mmol / L） are independent risk factors for stroke in NVAF patients with low- intermediate CHADS2 score. CHA2DS2- VASc score system is advantageous than CHADS2 score system in the risk classification of NVAF patients with low- intermediate risk of stroke. The application of CHA2DS2- VASc score system in China needs further verification and adjustment.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第19期2290-2293,2305,共5页
Chinese General Practice
关键词
非瓣膜性心房纤颤
卒中
危险因素
Non-valvular atrial fibrillation
Stroke
Risk factors
