天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (3): 304-307.doi: 10.11958/j.issn.0253-9896.2015.03.022

• 应用研究 • 上一篇    下一篇

CHADS2及 CHA2DS2-VASc 评分对非瓣膜性心房颤动患者左心房/左心耳血栓的预测价值

马军伟， 马向红△， 崔利军， 李昭#br# #br#   

  1. 天津医科大学第二医院心脏科 （邮编 300211）

  • 收稿日期:2014-08-11 修回日期:2014-10-31 出版日期:2015-03-15 发布日期:2015-03-15
  • 通讯作者: 马向红 E-mail:majunwei1227@163.com
  • 作者简介:马军伟 （1988）， 男， 硕士在读， 主要从事心血管疾病基础与临床研究

The predictive value of CHADS2 and CHA2DS2-VASc score in left atrial or left atrial appendage thrombus in patients with non-valvular atrial fibrillation

MA Junwei， MA Xianghong△， CUI Lijun， LI Zhao#br# #br#   

  1. Department of Cardiology, The Second Hospital of Tianjin Medical University,Tianjin 300211, China

  • Received:2014-08-11 Revised:2014-10-31 Published:2015-03-15 Online:2015-03-15
  • Contact: MA Xianghong E-mail:majunwei1227@163.com

PDF (PC)

4251

摘要： 目的 探讨 CHADS2及 CHA2DS2-VASc 评分对非瓣膜性心房颤动（房颤）患者左心房（LA） /左心耳（LAA）血栓的预测价值。方法 连续纳入于我院行经食管心脏超声（TEE）检查的房颤患者 164 例， 分为血栓组和非血栓组。记录患者既往病史， 根据患者一般资料， 计算其 CHADS2及 CHA2DS2-VASc 评分， 同时收集患者实验室检查及心脏超声检查等指标， 比较 2 组资料的差别。结果 164 例患者中， 32 例 （19.5%） 经 TEE 检查存在 LA/LAA 血栓 （血栓组）， 血栓组患者 CHADS2及 CHA2DS2-VASc 评分高于非血栓组 （2.1±1.3 vs 1.0±0.9， 3.4±1.8 vs 1.9±1.4， P＜0.01）； 2 种评分方法结果， 卒中低危、 中危（≤1 分）患者分别有 13 例（11.9%）和 5 例（8.8%）存在 LA/LAA 血栓； 多因素 Logistic 回归分析显示， CHADS2 评分≥2 分（OR=3.735， 95%CI:1.508~9.251， P=0.004）和 CHA2DS2-VASc 评分≥2 分（OR= 5.104， 95%CI:1.586~16.425， P=0.006） 是心房颤动患者 LA/LAA 血栓形成的独立危险因素； ROC 曲线显示， CHADS2及 CHA2DS2- VASc 评分预测 LA/LAA 血栓的曲线下面积分别为 0.731（95%CI： 0.630～0.832，P＜0.001）和 0.742 （95%CI： 0.640～0.843， P＜0.001）。结论 CHADS2及 CHA2DS2-VASc 评分≥2 分是房颤患者 LA/LAA 血栓形成的独立危险因素， 2 种评分方法预测 LA/LAA 血栓价值中等； 2 种评分方法的卒中低危、 中危患者仍有 LA/LAA 血栓形成，且随着危险分层增高， LA/LAA 血栓比例增加。

关键词: 心房颤动, 经食管超声心动描记术, CHADS2评分, CHA2DS2-VASc 评分, 左心房/左心耳血栓

Abstract: Objective To investigate the predictive value of CHADS2 and CHA2DS2- VASc score in left atrial (LA) or left atrial appendage (LAA) thrombus in patients with non-valvular atrial fibrillation (AF). Methods A total of 164 consecu⁃ tive non-valvular AF patients confirmed by transesophageal echocardiography (TEE) were included in this study, and were divided into two groups, LA/LAA thrombus group and non LA/LAA thrombus group. The previous history was recorded in two groups of patients. Their CHADS2 and CHA2DS2-VASC scores were calculated based on the general data of two groups. The laboratory examinations and TEE indexes were compared between two gropes. Results Of all patients, the rate of LA/ LAA thrombus was 19.5%. The CHADS2 and CHA2DS2-VASC scores were significantly higher in LA/LAA thrombus group than those of non LA/LAA thrombus group (2.1±1.3 vs 1.0±0.9, 3.4±1.8 vs 1.9±1.4， P＜0.01). There were 13(11.9%) and 5 (8.8%) patients showed LA/LAA thrombus under low-moderate risk in the two score systems, respectively. Multivariate logis⁃ tic regression analysis showed that CHADS2 score ≥2 points(OR=3.735, 95%CI:1.508-9.251, P=0.004) and CHA2DS2-VASc score ≥2 points (OR=5.104, 95%CI:1.586- 16.425, P=0.006) were independent risk factors of LA/LAA thrombus. ROC curve showed that AUC of CHADS2 and CHA2DS2-VASc scores to predict LA/LAA thrombus were 0.731 (95%CI:0.630- 0.832, P＜0.001) and 0.742 (95%CI:0.640- 0.843, P＜0.001), respectively. Conclusion CHADS2 and CHA2DS2- VASC score ≥2 points are independent risk factors of LA/LAA thrombus in patients with non-valvular atrial fibrillation. The pre⁃ dictive values of both score systems are moderate. There are also LA/LAA thrombus in low-moderate risk patients when us⁃ ing the two score systems, and with the increased risk stratification, the rate of LA/LAA thrombus is increased.

Key words: atrial fibrillation, transesophageal echocardiography, CHADS2 score, CHA2DS2-VASc score, LA/LAA thrombus