南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (11): 1601-.

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CHADS2与CHA2DS2-VASc评分对非瓣膜病房颤患者左房血栓的风险评估

顾俊，贾锋鹏，封盼攀   

  • 出版日期:2014-11-20 发布日期:2014-11-20

CHADS2 versus CHA2DS2-VASc scoring systems for predicting left atrial thrombus in
patients with nonvalvular atrial fibrillation

  • Online:2014-11-20 Published:2014-11-20

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摘要： 目的评价CHADS2评分以及CHA2DS2-VASc评分与非瓣膜病房颤患者左房血栓的相关性，并比较两种评估系统评估结
果的不同。方法入选397例非瓣膜病房颤患者，分别行CHADS2评分以及CHA2DS2-VASc评分评估其血栓事件风险，比较两种
评估系统平均得分及危险分层的差异；并行经食道心脏超声检查了解左房血栓的发生率，分析两种评估系统不同评分与左房血
栓的相关性。结果CHA2DS2-VASc平均得分显著高于CHADS2平均得分（1.37±1.19 vs 0.63±0.78，P<0.001），CHA2DS2-VASc评
分高危组比例显著高于CHADS2评分（P<0.001），而低危组比例显著低于CHADS2评分（P<0.001）。经食道超声检查发现左房
血栓共44例，分析显示左房血栓发生率随CHADS2评分以及CHA2DS2-VASc评分危险分层增高而增加，不同得分组间有明显差
异（P<0.05）。单变量分析显示女性、年龄≥65 岁、左房内径≥38 mm、左室射血分数≤40%、高血压、糖尿病、冠心病、脑卒中、
CHADS2≥2分、CHA2DS2-VASc≥2分均和左房血栓有明显关系，但多变量logistic回归分析显示，仅CHA2DS2-VASc≥2分是唯一
预测左房血栓的指标（OR：9.85，95% CI：2.178-44.542，P<0.01）。结论CHA2DS2-VASc评估得分高于CHADS2评分，其具有优
于CHADS2评分的左房血栓预测能力。

Abstract: Objective To assess the correlation of CHADS2 and CHA2DS2-VASc scores for left atrial thrombus in patients with
nonvalvular atrial fibrillation and the differences in the results between the two scoring systems. Methods A total of 397
patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS2 and CHA2DS2-VASc scoring systems were
used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared.
The correlation of CHADS2 and CHA2DS2-VASc scores with left atrial thrombus was analyzed. Results The average score of
CHA2DS2-VASc was significantly higher than that of CHADS2 in these patients (1.37±1.19 vs 0.63±0.78, P<0.001). The proportion
of high-risk group was significantly higher (P<0.001) while that of low-risk group significantly lower as stratified by
CHA2DS2-VASc scores than by CHADS2 scores (P<0.001). Transesophageal echocardiography detected left atrial thrombus in 44
of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS2
or CHA2DS2-VASc scores (P<0.05). Univariate analysis showed that female gender, age ≥65 years, left atrium diameter ≥38
mm, left ventricular ejection fraction ≤40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS2≥2, and
CHA2DS2-VASc≥2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only
CHA2DS2-VASc ≥2 as the independent risk factor for left atrial thrombus (OR=9.85, 95%CI: 2.178-44.542, P<0.01). Conclusion
The average score of CHA2DS2-VASc is higher than that of CHADS2 and has better predictive ability for left atrial thrombus.