瓣膜性房颤血栓栓塞事件的危险因素和CHA2DS2-VASc评分对其血栓栓塞事件的预测价值

目的 分析瓣膜性房颤患者血栓栓塞危险因素和CHA2DS2-VASc评分对其血栓栓塞事件预测价值。 方法 纳入2016年9月至2019年9月就诊于本院的瓣膜性房颤患者137例，按是否发生血栓栓塞事件分为栓塞组（n=50)与非栓塞组（n=87)，在单因素分析基础上，进行多因素logistic回归分析判定血栓栓塞危险因素，并进行Cochran-Armitage趋势检验判断CHA2DS2-VASc评分与血栓栓塞是否存在线性趋势，制作ROC曲线，判定曲线下面积和截断点，并计算评价指标。 结果 研究组年龄≥75岁占比、女性患者占比、高血压、糖尿病、心衰患病率与对照组差异均无统计学意义，而两组间血管疾病患病率及CHA2DS2-VASc评分差异均有统计学意义（P<0.01）。多因素回归分析显示，血管疾病（OR: 7.463，95%CI 1.575-35.714，P<0.05）是卒中/TIA/血栓栓塞发生的独立危险因素；在控制其他变量后，CHA2DS2-VASc评分与卒中/TIA/血栓栓塞事件显著相关（OR: 2.688，95%CI: 1.776-4.065，P<0.01）及对栓塞事件预测的ROC曲线下面积为0.869（95%CI: 0.809-0.928，P<0.01）。Cochran-Armitage趋势检验显示CHA2DS2-VASc评分与卒中/TIA/血栓栓塞间存在线性趋势，卒中/TIA/血栓栓塞发生率随着CHA2DS2-VASc评分升高而升高（P<0.01）。 结论 血管疾病是瓣膜性房颤血栓栓塞事件发生的独立危险因素；CHA2DS2-VASc评分与此类患者血栓栓塞事件发生显著相关且对其预测价值较好。

Risk factors for thromboembolism events and predictive value of CHA2DS2-VASc for thromboembolism in valvular atrial fibrillation patients

AIM To analyze the risk factors for thromboembolism and the predictive value of thromboembolism events in valvular atrial fibrillation (AF) patients. METHODS A total of 137 valvular atrial fibrillation patients who were admitted to our hospital between September 2016 and September 2019 were included in this study. The patients were divided into group of patients with thromboembolism (study group, n=50) and group of patients without thromboembolism (control group, n=87). On the basis of univariate analysis, multivariate logistic regression analysis was conducted to explore the risk factors for thromboembolism and Cochran-Armitage trend test was conducted to explore whether there was a linear trend between CHA2DS2-VASc and the rates of thromboembolism. ROC curve was used to determine the area and cutoff point under it, and the corresponding evaluation indexes were calculated. RESULTS The proportion of patients aged ≥ 75 years and of female patients, and the prevalence of hypertension, diabetes and heart failure in the study group were not significantly different from those in the control group, but the prevalence of vascular disease and the CHA2DS2-VASC score were both significantly different between the two groups (P<0.01). After regression analysis, vascular disease (OR:7.463, 95%CI:1.575-35.714, P<0.05) was an independent risk factor for thromboembolism. After controlling for other variables, CHA2DS2-VASC score was significantly associated with the prevalence of thromboembolism events (OR: 2.688, 95%CI: 1.776-4.065, P<0.01) and the area under ROC curve for prediction of embolism events was 0.869 (95%CI :0.809-0.928, P<0.01). The Cochran-Armitage test showed a linear trend between CHA2DS2-VASc and the rates of thromboembolism events, and the incidence of thromboembolism events increased with the increase of CHA2DS2-VASc (P<0.01). CONCLUSIONS Vascular disease is an independent risk factor for the prevalence of stroke/transient ischemic attack/thromboembolism events in valvular AF patients. The CHA2DS2-VASC score is significantly associated with the prevalence of stroke/transient ischemic attack/thromboembolism events and has a good predictive value, and the incidence of stroke/transient ischemic attack/thromboembolism increases with the increase of CHA2DS2-VASc.