CAJ | 학술논문

目的：探讨 CHADS2评分及 CHA2DS2-VASc 评分预测老年非瓣膜性心房颤动(NVAF)合并缺血性脑卒中患者短期预后的意义。方法调查我院2011年6月至2013年8月老年医学科216例老年 NVAF 合并缺血性脑卒中患者,应用 CHADS2评分(0~6分)及 CHA2DS2-VASc 评分(0~9分)进行卒中风险评分,分为3组,低危组(0分)、中危组(1分)和高危组(2~9分),在发病后3个月时,采用改良 Rankin 量表(mRS)评定患者的预后,将患者分为预后良好和预后不佳组,比较两组临床资料、CHADS2评分及 CHA2DS2-VASc 评分差异,并进行 Logistic 回归分析。结果共纳入符合条件的206例(95.3％)患者,其中 CHADS2评分0、1、2~6分组各31、83、92例,CHA2DS2-VASc 评分0、1、2~9分组各24、78、104例,预后良好89例(43.2％),预后不佳117例(56.8％)。预后良好与预后不佳患者的年龄、性别、卒中史、CHADS2评分、CHA2DS2-VASc 评分的差异均有统计学意义(均为P ＜0.05)。多因素 Logistic 回归分析显示,年龄(OR：1.23,95％ CI：1.07~1.54, P =0.01)、CHADS2评分(OR：1.36,95％ CI：1.17~2.36, P =0.00)和 CHA2DS2-VASc 评分(OR：3.24,95％ CI：1.32~6.98,P =0.00)为预后不佳的独立预测因素。结论年龄、CHADS2评分和 CHA2DS2-VASc 评分是老年 NVAF 缺血性脑卒中患者短期预后不佳的独立预测因素；对于老年 NVAF 缺血性脑卒中早期病情改善的预测作用,CHA2DS2-VASc 评分优于 CHADS2评分。
목적：탐토 CHADS2평분급 CHA2DS2-VASc 평분예측노년비판막성심방전동(NVAF)합병결혈성뇌졸중환자단기예후적의의。방법조사아원2011년6월지2013년8월노년의학과216례노년 NVAF 합병결혈성뇌졸중환자,응용 CHADS2평분(0~6분)급 CHA2DS2-VASc 평분(0~9분)진행졸중풍험평분,분위3조,저위조(0분)、중위조(1분)화고위조(2~9분),재발병후3개월시,채용개량 Rankin 량표(mRS)평정환자적예후,장환자분위예후량호화예후불가조,비교량조림상자료、CHADS2평분급 CHA2DS2-VASc 평분차이,병진행 Logistic 회귀분석。결과공납입부합조건적206례(95.3％)환자,기중 CHADS2평분0、1、2~6분조각31、83、92례,CHA2DS2-VASc 평분0、1、2~9분조각24、78、104례,예후량호89례(43.2％),예후불가117례(56.8％)。예후량호여예후불가환자적년령、성별、졸중사、CHADS2평분、CHA2DS2-VASc 평분적차이균유통계학의의(균위P ＜0.05)。다인소 Logistic 회귀분석현시,년령(OR：1.23,95％ CI：1.07~1.54, P =0.01)、CHADS2평분(OR：1.36,95％ CI：1.17~2.36, P =0.00)화 CHA2DS2-VASc 평분(OR：3.24,95％ CI：1.32~6.98,P =0.00)위예후불가적독립예측인소。결론년령、CHADS2평분화 CHA2DS2-VASc 평분시노년 NVAF 결혈성뇌졸중환자단기예후불가적독립예측인소；대우노년 NVAF 결혈성뇌졸중조기병정개선적예측작용,CHA2DS2-VASc 평분우우 CHADS2평분。
Objective To assess the correlation of CHADS2 and CHA2DS2-VASc scores for 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 and 206 patients with nonvalvular atrial fibrillation were enrolled in this study. Patients were divided into 3 groups on the basis of CHADS2 scores (0,1,2 to 6) and CHA2DS2-VASc score (0,1,2 to 9) . And recovery was assessed by modified Rankin Scale (mRS) at 3 months follow-up (mRS≤2 reflected good prognosis and mRS ≥5 implicated unfavorable outcome). After screening the risk factors affecting prognosis using univariate analysis, the correlation of CHADS2 and CHA2DS2-VASc scores for short-term prognosis was estimated using Logistic regression model. Results The proportion of high-risk group was significantly higher (P < 0. 01) while that of low-risk group significantly lower as stratified by CHA2DS2-VASc score than by CHADS2 scores ( P < 0. 01 ) . Logistic regression model results suggested that CHA2DS2-VASc score was an independent predictor of good prognosis and unfavorable outcome. CHADS2≥2, and CHA2DS2-VASc≥2 were all correlated with prognosis, but multivariate logistic analysis identified only CHA2DS2-VASc≥2 as the independent risk factor for prognosis (OR = 3. 24, 95% CI:1. 32 - 6. 98,P= 0. 00). Conclusions The average score of CHA2DS2-VASc is higher than that of CHADS2 and has better predictive ability for prognosis in acute ischemic stroke patients with nonvalvular atrial fibrillation.