摘要目的 比较CHADS2评分和CHA2DS2-VASc评分预测非瓣膜病房颤患者卒中风险的优劣性.方法 入选2004年1月至2013年3月在我院住院治疗的合并急性缺血性卒中的非瓣膜病房颤患者,分别计算卒中前CHADS2评分(总分0～6分)和CHA2DS2-VASc评分(总分0～9分),按0、1、≥2分分为低、中、高危3组,比较2种评分系统在相同危险组间的差异.结果 共入选599例患者,男性320例(53.4％),平均年龄(75.4±9.1)岁.CHADS2评分低危组30例(5.0％),高于CHA2DS2-VASc评分低危组的6例(1.0％)(x2 =22.04,P＜0.001);CHADS2评分中危组132例(22.0％),高于CHA2 DS2-VASc评分中危组的25例(4.2％)(x2 =84.81,P＜0.001);CHADS2评分高危组437例(73.0％),低于CHA2DS2-VASc评分高危组的568例(94.8％) (X2=131.00,P＜0.001).一致性分析提示2种评分方法在3组的一致性均较差(Kappa值依次为0.322、0.075及0.257).结论 CHA2DS2-VASc评分对非瓣膜病房颤患者缺血性卒中的预测优于CHADS2评分.

abstractsObjective To compare the value between CHADS2 score and CHA2 DS2-VASc score on assessing the risk of ischemic stroke in patients with nonvalvular atrial fibrillation.Methods In this retrospective study,nonvalvular atrial fibrillation patients with acute ischemic stroke hospitalized from January 2004 to March 2013 in our department were included.CHADS2 score (range,0-6) and CHA2DS2-VASc score (range,0-9) before acute ischemic stroke was calculated.For both schemes,patients were also classified with scores of 0,1 and ≥ 2 in low-risk,intermediated-risk and high-risk categories,respectively,the difference between the two risk stratification schemes was evaluated by each category.Results A total of 599 patients [320 men,mean age (75.4 ± 9.1) years] were collected.According to CHADS2 score,30(5.0％),132(22.0％) and 437(73.0％) patients were classified in the low-risk,intermediated-risk and high-risk categories,respectively.The corresponding classification by CHA2DS2-VASc score was 6 (1.0％),25 (4.2％) and 568 (94.8％) cases.The number of low-risk category patients (5.0％ vs.1.0％,X2 =22.04,P ＜ 0.001) and in intermediate-risk category patients (22.0％ vs.4.2％,x2 =84.81,P ＜ 0.001,Kappa =0.075) was significantly higher in CHADS2 score group than in CHA2DS2-VASc score group,and the consistence between the two scores was poor (Kappa =0.322).There were less patients classified in the high-risk group by CHADS2 score compared to CHA2DS2-VASc score (73.0％ vs.94.8％,x2 =131.00,P ＜0.001,Kappa =0.257).Conclusion Compared with CHADS2 score,CHA2DS2-VASc score is more valuable in predicting ischemic stroke for patients with nonvalvular atrial fibrillation.