天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (3): 281-284.doi: 10.11958/20202253

• 临床研究 • 上一篇    下一篇

R2CHA2DS2-VASc评分对急性心肌梗死后发生急性心力衰竭风险的预测价值

李馨航1，李沅洋1，孙旭森2，齐新3，魏丽萍3△   

  1. 1天津中医药大学（邮编301600）；2复旦大学附属华东医院；3天津市人民医院心脏内科
  • 收稿日期:2020-08-11 修回日期:2020-12-25 出版日期:2021-03-15 发布日期:2021-03-15
  • 通讯作者: 魏丽萍 E-mail:weilipingme@163.com
  • 作者简介:李馨航（1994），女，硕士在读，主要从事心血管方面研究。E-mail：lxh15667279286@163.com
  • 基金资助:
    京津冀基础研究合作专项（19JCZDJC63900）；天津市科技计划项目（16ZXMJSY00060）

The predictive value of R2CHA2DS2-VASc score for the risk of acute heart failure after acute myocardial infarction

LI Xin-hang1, LI Yuan-yang1, SUN Xu-sen2, QI Xin3, WEI Li-ping3△   

  1. 1 Tianjin University of Traditional Chinese Medicine, Tianjin 301600, China; 2 Huadong Hospital Affiliated to Fudan University; 3 Department of Cardiology, Tianjin Union Medical Center
  • Received:2020-08-11 Revised:2020-12-25 Published:2021-03-15 Online:2021-03-15

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摘要： 目的　建立R2CHA2DS2-VASc评分评估急性心肌梗死（AMI）后急性心力衰竭（AHF）的发生风险并探讨该评分的预测价值。方法　回顾性分析2019年1月—12月因AMI于天津市人民医院住院治疗的患者139例，依据入院后是否发生AHF，分为无AHF组94例及AHF组45例。计算R2CHA2DS2-VASc评分，采用Spearman相关分析评估R2CHA2DS2-VASc评分与Killip分级及N末端B型利钠肽原（NT-proBNP）的相关性，多因素Logistic回归分析AMI后发生AHF的危险因素。采用受检者工作特征（ROC）曲线评价R2CHA2DS2-VASc评分对AMI患者发生AHF的预测价值。结果　AHF组患者糖尿病史、缺血性脑卒中/短暂性脑缺血发作（TIA）病史、心力衰竭病史的比例，NT-proBNP，Gensini评分及R2CHA2DS2-VASc评分高于无AHF组（P＜0.05）。Spearman相关分析提示R2CHA2DS2-VASc评分分别与Killip分级及NT-proBNP呈正相关（rs分别为0.539和0.506，P＜0.05）。多因素Logistic回归分析提示R2CHA2DS2-VASc评分≥4分和Gensini评分≥60分是AMI后发生AHF的独立危险因素。ROC曲线结果为R2CHA2DS2-VASc评分曲线下面积为0.826（95%CI：0.751~0.900），敏感度和特异度分别为57.8%和92.6%。结论　R2CHA2DS2-VASc评分对AMI后发生AHF有一定的预测价值。

关键词: 心肌梗死, 心力衰竭, 急性病, R2CHA2DS2-VASc评分

Abstract: Objective　To investigate the predictive value of R2CHA2DS2-VASc score in acute heart failure (AHF) after acute myocardial infarction (AMI). Methods　A total of 139 patients with AMI were enrolled in Tianjin Union Medical Center from January 2019 to December 2019. According to the presence of AHF after AMI in hospital, the patients were divided into the non-AHF group (n=94) and AHF group (n=45). General clinical data were used to calculate R2CHA2DS2-VASc score and to compare between the two groups. Spearman correlation analysis was performed to estimate the correlation between R2CHA2DS2-VASc score and Killip grading, and the correlation between R2CHA2DS2-VASc score and N-terminal pro-B type natriuretic peptide (NT-proBNP). Multivariate Logistic regression analysis were performed to estimate the contribution of clinical risk factors to trigger AHF after AMI. The value of the score in predicting AHF in patients with AMI was evaluated by ROC curve. Results　Proportion of diabetes mellitus history, proportion of ischemic stroke/transient ischemic attack (TIA) history, proportion of heart failure history, NT-proBNP, Gensini score and R2CHA2DS2-VASc score were significantly higher in AHF group than those in non-AHF group (P＜0.05). Spearman correlation analysis showed that R2CHA2DS2-VASc score was positively correlated with Killip grading and NT-proBNP (rs = 0.539 and 0.506 respectively, P＜0.05). Multivariate Logistic regression analysis suggested that R2CHA2DS2-VASc score ≥ 4 and Gensini score ≥60 were the independent risk factor for AHF after AMI. The ROC analysis revealed the area under the R2CHA2DS2-VASc score curve was 0.826 (95%CI: 0.751-0.900), and the sensitivity and specificity were 57.8% and 92.6%, respectively. Conclusion　R2CHA2DS2-VASc score has the value of predicting AHF after AMI.

Key words: myocardial infarction, heart failure, acute disease, R2CHA2DS2-VASc score