【作者】 刘燕；

【导师】 龚辉；

【作者基本信息】 复旦大学 ， 全科医学（专业学位）， 2013， 硕士

【摘要】 研究背景随着社会老龄化及各种因素的变化,心律失常,尤其是非瓣膜性心房颤动(NVAF)的发病率逐年上升。由此导致的脑卒中成了社会的负担。如何判断心房颤动高危病人,及早发现及早干预,成为当前的热点。2010年欧洲房颤管理指南中纳入CHADS2及CHA2DS2-VASc卒中风险预测模型对房颤患者卒中风险进行分层。CHADS2评分系统使用简单且广泛普及,但在卒中低中危风险患者的辨别方面存在局限性,相比之下CHA2DS2-VASc评分通过纳入其他临床和实验室卒中危险因素进一步提高了风险分辨能力,但增加成本并削弱了其使用方便性。国内尚未对CHADS2评分的卒中风险分层价值进行过验证。随着卒中预防效果更好和出血并发症风险更低的新型口服抗凝药的出现,有必要对现有CHADS2评分进行改良并验证。目的探讨非瓣膜性心房颤动CHADS2评分低中危患者发生脑卒中的危险因素。方法选择2009年1月至2012年12月在我院神经内科住院的NVAF合并脑卒中患者(n=98),计算CHADS2评分,CHA2DS2-VASc评分,筛选CHADS2评分低中危(0～2为低中危)患者为病例组(n=58),选择同期在我院心内科住院的NVAF不合并脑卒中患者为对照组(n=53)。结果98例NVAF合并脑卒中患者中CHADS2评分高危患者40例,98例NVAF合并脑卒中患者中CHA2DS2-VASc评分≥2分者95例。病例组吸烟史、心力衰竭、冠心病史、心率<80次／分的发生率及谷丙转氨酶、肌酐、胆固醇、低密度脂蛋白(LDL)、脂蛋白a、射血分数(EF)与对照组的差异均有统计学意义(P<0.05)。多元非条件Logistic回归分析：心率<80次／分、高胆固醇均与CHADS2评分低中危患者发生脑卒中显著相关(P<0.05)。结论患者心率<80次／分、高胆固醇为CHADS2评分低中危患者发生脑卒中的独立危险因素。CHA2DS2-VASc评分系统对低中危患者的风险分层优于CHADS2评分系统。更多还原

【Abstract】 BackgroundAlong with the social changes, aging and various factors of arrhythmia, especially non valvular atrial fibrillation (NVAF) incidence increased year by year and NVAF associated stroke become a heavy burden to society. How to identify high-risk patients with atrial fibrillation early and perform early intervention has become the focus of clinical practice. In2010, the European guidelines for management of atrial fibrillation published, the CHADS2and CHA2DS2-VASc score sytem of incorporated forecasting model was used to stratify risk of stroke in patients with atrial fibrillation. CHADS2scoring system is easy to use and now widely spreaded. But in patients with low-intermediate risk identification of stroke, CHADS2has limitations compared with CHA2DS2-VASc score system, CHA2DS2-VASc score system included other clinical and laboratory risk factors of stroke and further increased the risk of resolution. But because of the cost increasing and its inconvenience, its use is limited. Stroke risk stratification value is not yet verified on CHADS2score in Chinese population. With the stroke prevention effect is better and the new oral anticoagulants appeared which with lower risk of bleeding complications, it is necessary to modify and verify the existing CHADS2score.ObjectiveTo investigate the risk factors for stroke in non-valvular atrial fibrillation (NVAF) patients with low-intermediate risk CHADS2score.MethodsA total of98NVAF with stroke and53NVAF without stroke patients in our hospital from2009to2012were retrospectively analyzed. The CHADS2and CHA2DS2-VASc scores were calculated. The patients were divided into two groups as stroke patients with NVAF and CHADS2(0-2) [NVAF+stroke+CHADS2(0-2)], n=58and patients with NVAF without stroke(control group), n=53.The related risk factors for stroke were investigated and compared between two groups.ResultsThe patients in NVAF+stroke+CHADS2(0-2) group presented higher levels of plasma total cholesterol, higher level of low density lipoprotein-cholesterol(LDL-c) and lipoprotein(a)[Lp(a)], higher levelof left ventricular ejection (LVEF). The patients in NVAF+stroke+CHADS2(0-2)group presented lower heart rate(HR), higher rate of smoking history, coronary heart disease and heart failure(HF), lower levels of plasma alanine aminotransferase (ALT), creatinine (Cr) compared with the control group, P<0.05respectively. Multivariate logistic regression analysis indicated that the high total cholesterol and HR<80bpm were closely related to stroke with low-intermediate CHADS2score.ConclusionsThe total cholesterol and HR<80bpm were the independent risk factors for stroke in NVAF patients with low-intermediate CHADS2risk score. The CHA2DS2-VASc score might have a great impact in cardioembolic stroke prevention not only by improving risk stratification but also by increasing the number of patients with AF in whom anticoagulation is appropriately recommended.更多还原