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CHA2 DS2-VASc 评分对初发心源性卒中预后判断的应用研究

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

摘要:

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。

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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 .

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