摘要目的:探讨CHADS 2和CHA 2DS 2-VASc评分与隐源性卒中（cryptogenic stroke, CS）患者功能转归的相关性。 方法:回顾性纳入2021年2月至2024年1月苏州市中医医院脑病科收治的CS患者。根据发病后3个月时改良Rankin量表（modified Rankin Scale, mRS）评分，分为转归良好组（0~2分）和转归不良组（>2分）。采用多变量 logistic回归分析确定转归不良的独立危险因素。采用限制性立方样条（restricted cubic splines, RCS）模型分析剂量反应关系。采用受试者工作特征（receiver operating characteristic, ROC）曲线评估预测效能。 结果:共纳入184例患者，男性121例（65.76%），年龄（61.32±7.98）岁；基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分（3.82±1.09）分；116例（63.04%）转归良好，68例（36.96%）转归不良。转归不良组年龄、基线NIHSS评分、发病至入院时间、CHADS 2评分、CHA 2DS 2-VASc评分以及糖尿病的患者比例均显著高于转归良好组（ P均<0.05）。多变量 logistic回归分析显示，基线NIHSS评分[优势比（odds ratio, OR）5.224，95%置信区间（confidence interval, CI）1.119~14.527； P=0.002]、CHADS 2评分（ OR 3.247，95% CI 1.427~6.814； P=0.024）、CHA 2DS 2-VASc评分（ OR 3.849，95% CI 1.540~7.531； P=0.019）为转归不良的独立危险因素。RCS模型分析显示，CHADS 2和CHA 2DS 2-VASc评分与转归不良风险呈非线性剂量反应关系（ P均<0.001）。CHADS 2和CHA 2DS 2-VASc评分预测转归不良的曲线下面积分别为0.693（95% CI 0.581~0.760）和0.729（95% CI 0.624~0.813），CHA 2DS 2-VASc评分的预测效能更优。 结论:CHADS 2和CHA 2DS 2-VASc评分均为CS患者转归不良的独立危险因素，CHA 2DS 2-VASc评分对转归不良的预测效能优于CHADS 2。

abstractsObjective:To investigate associations of CHADS 2 and CHA 2DS 2-VASc scores with functional outcome in patients with cryptogenic stroke (CS). Methods:Patients with CS admitted to the Department of Encephalopathy, Suzhou Hospital of Traditional Chinese Medicine from February 2021 to January 2024 were included retrospectively. According to the modified Rankin Scale (mRS) score at 3 months after onset, they were divided into a good outcome group (0-2) and a poor outcome group (>2). Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcome. Restricted cubic spline (RCS) model was used to analyze the dose-response relationship. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy. Results:A total of 184 patients were enrolled, including 121 males (65.76%), aged 61.32±7.98 years. Baseline National Institutes of Health Stroke Scale (NIHSS) score 3.82±1.09. One hundred and sixteen patients (63.04%) had good outcome, and 68 patients (36.96%) had poor outcome. Age, baseline NIHSS score, onset-to-door time, CHADS 2 score, CHA 2DS 2-VASc score, and the proportion of patients with diabetes in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio [ OR] 5.224, 95% confidence interval [ CI] 1.119-14.527; P=0.002), CHADS 2 score ( OR 3.247, 95% CI 1.427-6.814; P=0.024), and CHA 2DS 2-VASc score ( OR 3.849, 95% CI 1.540-7.531; P=0.019) were the independent risk factors for poor outcome. RCS model analysis showed a non-linear dose-response relationship between the CHADS 2/CHA 2DS 2-VASc scores and poor outcome (all P<0.001). The area under the curve of CHADS 2 and CHA 2DS 2-VASc scores for predicting poor outcome were 0.693 (95% CI 0.581-0.760) and 0.729 (95% CI 0.624-0.813), respectively, indicating that CHA 2DS 2-VASc score had better predictive efficacy. Conclusion:Both CHADS 2 and CHA 2DS 2-VASc scores are the independent risk factors for poor outcome in patients with CS, and the predictive efficacy of CHA 2DS 2-VASc score for poor outcome is superior to that of CHADS 2 score.