CAJ | 학술논문

目的：研究CHA2DS2-VASc评分与颅内动脉粥样硬化、卒中分型、早期预后的关系，以评价CHA2DS2-VASc评分的临床价值。方法回顾性分析149例非瓣膜性房颤（non-valvular atrial fibrillation，NVAF）缺血性脑卒中患者的临床表现、常规实验室检查、彩超和颅脑CT等辅助检查，以及CHA2DS2-VASc评分、中国缺血性卒中亚型（Chinese ischemic stroke subclassification，CISS）分型、入院和出院时美国国立卫生研究院卒中量表（National Insti-tutes of Health stroke scale，NIHSS）评分等。结果合并颅内动脉粥样硬化的患者以及CHA2DS2-VASc评分高于未合并者[（5.13±1.39）vs.（4.14±1.67）]，差异有统计学意义（P＜0.05）；不同CHA2DS2-VASc评分组（0~1分组，2~3分组，4~5分组，≥6分组）患者合并颅内动脉硬化的分布情况有统计学差异（P＜0.05）。CS+LAA组与CS+LAA+PAD组患者CHA2DS2-VASc评分分别与CS组、CS+PAD组患者比较均有统计学差异（均P＜0.01）。不同CHA2DS2-VASc评分组患者病情改善情况比较有统计学差异（P＜0.05）；病情改善组与未改善组的患者CHA2DS2-VASc评分比较亦存在统计学差异（P＜0.05）。结论较高的CHA2DS2-VASc评分与NVAF缺血性脑卒中患者合并颅内动脉粥样硬化机率增加有关；CHA2DS2-VASc评分可以帮助推测NVAF患者发生缺血性脑卒中的类型和发病机制；CHA2DS2-VASc评分与NVAF缺血性脑卒中严重程度及早期病情改善相关。
목적：연구CHA2DS2-VASc평분여로내동맥죽양경화、졸중분형、조기예후적관계，이평개CHA2DS2-VASc평분적림상개치。방법회고성분석149례비판막성방전（non-valvular atrial fibrillation，NVAF）결혈성뇌졸중환자적림상표현、상규실험실검사、채초화로뇌CT등보조검사，이급CHA2DS2-VASc평분、중국결혈성졸중아형（Chinese ischemic stroke subclassification，CISS）분형、입원화출원시미국국립위생연구원졸중량표（National Insti-tutes of Health stroke scale，NIHSS）평분등。결과합병로내동맥죽양경화적환자이급CHA2DS2-VASc평분고우미합병자[（5.13±1.39）vs.（4.14±1.67）]，차이유통계학의의（P＜0.05）；불동CHA2DS2-VASc평분조（0~1분조，2~3분조，4~5분조，≥6분조）환자합병로내동맥경화적분포정황유통계학차이（P＜0.05）。CS+LAA조여CS+LAA+PAD조환자CHA2DS2-VASc평분분별여CS조、CS+PAD조환자비교균유통계학차이（균P＜0.01）。불동CHA2DS2-VASc평분조환자병정개선정황비교유통계학차이（P＜0.05）；병정개선조여미개선조적환자CHA2DS2-VASc평분비교역존재통계학차이（P＜0.05）。결론교고적CHA2DS2-VASc평분여NVAF결혈성뇌졸중환자합병로내동맥죽양경화궤솔증가유관；CHA2DS2-VASc평분가이방조추측NVAF환자발생결혈성뇌졸중적류형화발병궤제；CHA2DS2-VASc평분여NVAF결혈성뇌졸중엄중정도급조기병정개선상관。
Objective To study the relationship between CHA2DS2-VASc score and intracranial atherosclerosis, Chinese ischemic stroke subclassification (CISS) classification and the early neurological outcomes in ischemic stroke pa-tients with non-valvular atrial fibrillation (NVAF), and to evaluate the clinical value of CHA2DS2-VASc score. Methods The retrospective analysis method was used. The data from 149 cases of ischemic stroke patients with NVAF was retro-spectively analyzed. The clinical data mainly included clinical manifestations, routine lab tests, imaging examinations such as the color-echo doppler, brain CT and/or MRI and angiographic studies of CTA and/or MRA of brain, CHA2DS2-VASc score, the CISS and the National Institutes of Health stroke scale (NIHSS). Results The CHA2DS2-VASc score was significantly higher in patients with intracranial atherosclerosis than those without [(5.13±1.39) vs. (4.14±1.67)] (P<0.05). The occurrence rates of intracranial atherosclerosis were significantly different among different CHA 2DS2-VASc score subgroups (0~1, 2~3, 4~5 and≥6 subgroups) (P<0.05). There were significant differences in CHA2DS2-VASc score among CS+LAA group, CS+LAA+PAD,group CS, group and CS+PAD group (all P<0.05). There was statistical difference in CHA2DS2-VASc score between patients with and without improvements (P<0.05). Conclusion The CHA2DS2-VASc score may be associated with concomitant intracranial atherosclerosis of ischemic stroke patients with NVAF which can be used to predict the condition of intracranial atherosclerosis. The CHA2DS2-VASc score is positively correlated with se-verity of ischemic stroke with NVAF which can be used to predict the disease improvements in patient with NVAF.