CAJ | 학술논문

目的探讨CHADS2评分与合并非瓣膜性房颤的急性缺血性卒中患者近期预后的关系.方法前瞻性纳入发病7d内合并非瓣膜性房颤的卒中患者,行发病前CHADS2评分,分3组(0～1、2、3～6分),随访住院期间并发症和3个月时预后情况[改良Rankin量表评分(mRS)≤2为预后良好,mRS≥5为预后极差],单因素分析筛选影响3个月预后的危险因素后,再采用Logistic逐步回归分析CHADS2评分与3个月预后的关系.结果共纳入203例患者,其中CHADS2 0～1、2、3～6组各72、53、78例,CHADS2评分高者入院时NIHSS评分较高,均数分别为9.8、12.6、13.0(F =3.404,P =0.035)；肺部感染发生率较高,分别为12.5％、34.0％、39.7％( X2=14.643,P=0.001)；预后良好率较低；预后极差率较高；多因素Logistic回归分析显示CHADS2评分是预后良好和预后极差的独立预测因子,以CHADS23～6组为参考,CHADS20～1预测良好预后的OR值为5.018(95％ CI为2.055 ～ 12.560)；以CHADS2 0～1组为参考,CHADS23～6预测极差预后的OR值为6.197(95％ CI为1.670～22.996).结论发病前CHADS2评分与合并非瓣膜性房颤的缺血性卒中患者预后相关,评分低者(0～1)预后良好可能性大,评分高者(3～6)预后极差可能性大.
목적 탐토CHADS2평분여합병비판막성방전적급성결혈성졸중환자근기예후적관계.방법 전첨성납입발병7d내합병비판막성방전적졸중환자,행발병전CHADS2평분,분3조(0～1、2、3～6분),수방주원기간병발증화3개월시예후정황[개량Rankin량표평분(mRS)≤2위예후량호,mRS≥5위예후겁차],단인소분석사선영향3개월예후적위험인소후,재채용Logistic축보회귀분석CHADS2평분여3개월예후적관계.결과 공납입203례환자,기중CHADS2 0～1、2、3～6조각72、53、78례,CHADS2평분고자입원시NIHSS평분교고,균수분별위9.8、12.6、13.0(F =3.404,P =0.035)；폐부감염발생솔교고,분별위12.5％、34.0％、39.7％( X2=14.643,P=0.001)；예후량호솔교저；예후겁차솔교고；다인소Logistic회귀분석현시CHADS2평분시예후량호화예후겁차적독립예측인자,이CHADS23～6조위삼고,CHADS20～1예측량호예후적OR치위5.018(95％ CI위2.055 ～ 12.560)；이CHADS2 0～1조위삼고,CHADS23～6예측겁차예후적OR치위6.197(95％ CI위1.670～22.996).결론 발병전CHADS2평분여합병비판막성방전적결혈성졸중환자예후상관,평분저자(0～1)예후량호가능성대,평분고자(3～6)예후겁차가능성대.
Objective To explore the relationship between the CHADS2 score and short-term prognosis in acute ischemic stroke patients with nonvalvular atrial fibrillation. Methods Consecutive ischemic stroke patients with nonvalvular atrial fibrillation who were hospitalized within 7 days after stroke were registered.Patients were divided into 3 groups on the basis of CHADS2 pre-stroke score (0 to 1,2,3to 6).And recovery was assessed by modified Rankin Scale (mRS) at 3 months follow-up (mRS ≤ 2reflected good prognosis,and mRS ≥ 5 implicated unfavorable outcome).After screening the risk factors affecting prognosis using univariate analysis,the relationship between CHADS2 score and prognosis was estimated using logistic regression model.Results Of 203 patients enrolled,the CHADS2 score of 0-1,2,3-6 were present in 72,53 and 78 respectively.Patients with the higher CHADS2 score had a higher initial NIHSS score (9.8,12.6,13.0,F =3.404,P =0.008 ),more likely to receive nosocomial pulmonary infection( 12.5％,34.0％,39.7％,x2 =14.643,P =0.001 ),negatively related to good prognosis (x2 =28.542,P =0.000 ) and positively related to unfavorable outcome ( x2 =23.575,P =0.000 ).Logistic regression model results suggested that CHADS2 score was an independent predictor of good prognosis and unfavorable outcome. Compared with CHADS2 score 3-6, CHADS2 score 0-1 was independently associated with good prognosis ( OR =5.018,95 ％ CI 2.055-12.560 ).And compared with CHADS2 score 0-1,CHADS2 score 3-6 was independently associated with unfavorable outcome ( OR =6.197,95％ CI1.670-22.996 ).Conclusions CHADS2 pre-stroke score appears to be useful in prediction of stroke outcome for patients with nonvalvular atrial fibrillation.After acute ischemic stroke,the patients with the lower CHADS2 score (0-1) are more likely to achieve good prognosis,inversely,the patients with the higher CHADS2 score (3-6) are more likely to achieve unfavorable outcome.