CHA2 DS2-VASc 评分对初发心源性卒中预后判断的应用研究

目的：研究CHA2DS2-VASc[congestive heart failure，hypertension，age≥75y（doubled），diabetes mellitus，stroke （doubled）-vascular disease，age 65-74 and sex category（female）]评分与合并心房颤动的初发心源性卒中预后之间的关系。方法收集346例初发心源性卒中患者的相关临床资料，起病时的美国卫生研究院卒中量表（ National Institutes of Health Stroke Scale，NIHSS）评分以及90 d时改良Rankin量表（ modified Rankin Scale ，mRS）评分和CHA2 DS2-VASc评分，并对其进行分析。结果年龄、性别（女性）、吸烟史、高血压病史、充血性心衰病史、既往抗凝治疗史、入院时NHISS评分和CHA2 DS2-VASc评分在不同预后组中差异有统计学意义（ P ＜0.05）。 CHA2DS2-VASc评分与NIHSS评分（ρ＝0.324， P ＜0.01），mRS评分（ρ＝0.228， P ＜0.01）呈正相关，多因素Logistic逐步回归分析显示年龄、吸烟、抗凝治疗、CHA2 DS2-VASc评分、NIHSS评分是预测初发心源性卒中预后的独立因素。结论 CHA2 DS2-VASc评分不仅能够用于心房颤动患者卒中风险分层，而且还能预测卒中合并房颤患者的预后。

Application study of the CHA2 DS2-VASc score in the prognosis assessment of an initial cardioembolic stroke with atrial fi-brillation

Objective To investigate prognostic value of the CHA 2 DS2-VASc score [ congestive heart failure , hypertension , age≥75y （doubled）, diabetes mellitus, stroke （doubled）-vascular disease, age 65-74 and sex category （female）] in an initial car-dioembolic stroke with atrial fibrillation .Methods A total of 346 initial cardioembolic stroke patients with atrial fibrillation was en-rolled.The clinical feature, the National Institutes of Health Stroke Scale （NIHSS） score on admission, and clinical outcome [modi-fied Rankin Scale （mRS） score after 90 days] were obtained and evaluated retrospectively according to the CHA 2DS2-VASc score. Results The rate of female, smoking, hypertension, congestive heart failure, anticoagulation and the level of age, NIHSS score, and CHA2 DS2-VASc score were significantly different between two prognostic groups （ P 〈0.05 ） .A positive correlation was observed be-tween CHA2DS2-VASc score and NIHSS score on admission （ρ=0.324, P 〈0.01）, CHA2DS2-VASc score and mRS score （ρ=0.228, P 〈0.01）.Logistic regression analysis showed that age , smoking, anticoagulation, the CHA2DS2-VASc score, and the NIH-SS score on admission were related to clinical outcome independently .Conclusions The CHA2 DS2-VASc score may be useful for not only evaluation of stroke risk but also prediction of clinical outcomes after stroke .