南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (06): 786-792.doi: 10.12122/j.issn.1673-4254.2020.06.03

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CHA2DS2-VASc评分预测非房颤人群首发缺血性脑卒中幸存者复发风险的效果评价

杨燕玲，严 可，李亚文，姚 强，蒋 敏，朱彩蓉   

  • 出版日期:2020-06-20 发布日期:2020-06-20
  • 基金资助:

Value of CHA2DS2-VASc score in predicting stroke recurrence in first-ever ischemic stroke survivors without atrial fibrillation

  

  • Online:2020-06-20 Published:2020-06-20

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摘要： 目的 探讨CHA2DS2-VASc评分是否可用于非房颤人群首发缺血性脑卒中幸存者复发风险预测。方法 本研究共纳入768例非房颤首发缺血性脑卒中幸存者，男性475例（61.85%），女性293例（38.15%），年龄为61.52±12.59（17~90）岁。基线信息采用面对面问卷调查及查阅电子病历收集，随访信息采用3月1次的电话随访收集；采用χ2检验和Wilcoxon秩和检验比较正常随访者与失访者的基线特征；采用ROC曲线下面积（AUC）及灵敏度、特异度、阳性似然比等指标；构建Cox比例风险模型，计算C指数；评价CHA2DS2-VASc评分对非房颤人群首发缺血性脑卒中幸存者不同随访时间内复发风险的预测效果。结果 脑卒中1年、3年、5年复发率分别为10.59%、20.45%、29.46%。该评分预测非房颤人群首发缺血性脑卒中幸存者1年、3年和5年复发风险AUC值（95%CI）、最佳工作点及对应的阳性似然比分别为0.558（0.492-0.624）、4.5、1.256；0.574（0.517-0.630）、4.5、1.397；0.604（0.548-0.661）、4.5、1.655。对“充血性心力衰竭”项进行敏感性分析后提示CHA2DS2-VASc评分的预测效果基本不变。结论 CHA2DS2-VASc评分可用于非房颤人群首发缺血性脑卒中幸存者3年和5年复发风险预测，对长期脑卒中复发的预测效果更好，但预测价值均较低，建议今后可尝试对该评分进行改进或建立新的评分。

Abstract: Objective To test the performance of CHA2DS2-VASc score in predicting stroke recurrence in first-ever ischemic stroke survivors without atrial fibrillation (AF). Methods A total of 768 patients were included in this study, including 475 male (61.85%) and 293 female patients (38.15%) with a mean age of 61.52±12.59 years (17-90 years). The baseline information of the patients was collected by face-to-face questionnaire survey and electronic medical record review, and their follow-up information was collected by telephone follow-up once every 3 months. Chi-square test and Wilcoxon rank sum test were used to compare the baseline characteristics between the patients regularly followed up and those withdrawn from the study. The area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio and other indicators of CHA2DS2-VASc score were determined, and C-index based on Cox proportional hazards model was used to evaluate the performance of CHA2DS2- VASc score in predicting the risk of stroke recurrence in patients at different time points during the follow-up. Results The 1-year, 3-year, and 5-year recurrence rate of stroke was 10.59%, 20.45%, and 29.46% in these patients, respectively. The AUC value, Optimal Operating Point (OOP) and the corresponding positive likelihood ratios (LR+) for predicting stroke recurrence were 0.558 (95%CI: 0.492-0.624), 4.5, and 1.256 at 1 year; 0.574 (95%CI: 0.517-0.630), 4.5, and 1.397 at 3 years; and 0.604 (95%CI: 0.548-0.661), 4.5, and 1.655 at 5 years, respectively. Sensitivity analysis of congestive heart failure showed that the predictive effect of CHA2DS2-VASc score was basically unchanged. Conclusion CHA2DS2-VASc score can be used to predict the 3-year and 5-year risk of stroke recurrence in first-ever ischemic stroke survivors without AF. The score has a better prediction ability for long-term stroke recurrence, but the prediction value remains low, suggesting the need to further improve the score or establish a new score for predicting stroke recurrence.