三种评分方法在缺血性卒中合并心房颤动筛查中的应用

发布时间：2018-12-26 18:14

【摘要】：目的探讨心房颤动筛查评分(STAF)和包括左心房直径(L)、年龄(A)、卒中/短暂性脑缺血发作(D)、发病前1年吸烟(S)4个指标的LADS评分以及包括年龄、美国国立卫生研究院卒中量表(NIHSS)评分、左心房扩大及血管病因4个指标的ASAS评分3种方法在缺血性卒中合并心房颤动患者筛查中的临床应用价值。方法回顾性分析2016年4月至2017年4月于广州医科大学附属第二医院神经内科住院的急性缺血性卒中患者317例的临床及影像学资料,依据患者是否合并心房颤动分为房颤组(56例)和非房颤组(261例),收集患者的性别、年龄、既往史、NIHSS评分、超声心动图结果及脑血管评估情况等相关临床资料,对所有患者分别进行STAF、LADS和ASAS评分,绘制受试者工作特征曲线(ROC),计算曲线下面积并比较3种方法预测缺血性卒中合并心房颤动发生的敏感度、特异度以及准确度。结果房颤组与非房颤组患者比较,年龄[(69±11)岁比(62±12)岁]、NIHSS评分[(8.2±1.3)分比(4.4±0.3)分]、左心房内径[(42.3±6.8)mm比(31.7±2.5)mm]差异均有统计学意义(t值分别为2.99、3.38、6.32,均P0.01)。STAF评分诊断缺血性卒中合并心房颤动的曲线下面积为0.801,最佳截断点为STAF≥5分,敏感度为58.9%,特异度81.2%,准确度77.3%;LADS评分诊断缺血性卒中合并心房颤动的曲线下面积为0.846,最佳截断点为LADS≥4分,敏感度66.1%,特异度83.5%,准确度80.4%;ASAS预测值评分诊断缺血性卒中合并心房颤动的曲线下面积为0.835,最佳截断点为ASAS预测值≥0.09分,敏感度85.7%,特异度56.7%,准确度61.8%;3种评分方法敏感度、特异度及准确度差异均有统计学意义(χ2值分别为10.308、59.685、32.054,均P0.01)。结论 LADS≥4分在筛选急性缺血性卒中合并心房颤动中的准确度最高。
[Abstract]:Objective to investigate the LADS scores of (STAF) and (A), stroke / transient ischemic attack (TIA) (S) in 4 indexes including left atrial diameter (L),) age, (A), stroke / transient ischemic attack (D), and the age of (S) smoking in the first year before the onset of Atrial Fibrillation (AF). The clinical application value of (NIHSS) score of stroke scale, ASAS score of left atrial enlargement and vascular etiology in the screening of ischemic stroke patients with atrial fibrillation. Methods the clinical and imaging data of 317 patients with acute ischemic stroke admitted to Department of Neurology, second affiliated Hospital of Guangzhou Medical University from April 2016 to April 2017 were retrospectively analyzed. Patients were divided into atrial fibrillation group (56 cases) and non-atrial fibrillation group (261 cases) according to whether they were complicated with atrial fibrillation. The related clinical data such as sex, age, past history, NIHSS score, echocardiographic results and cerebrovascular assessment were collected. All patients were scored with STAF,LADS and ASAS, and the area under the curve was calculated by drawing the operating characteristic curve (ROC),. The sensitivity, specificity and accuracy of the three methods in predicting the incidence of ischemic stroke with atrial fibrillation were compared. Results the age of patients with atrial fibrillation was (69 卤11) years old vs (62 卤12) years old, the NIHSS score was (8.2 卤1.3) points vs (4.4 卤0.3) years, and the age of patients with atrial fibrillation group was (69 卤11) years old vs (62 卤12) years old. The diameter of left atrium [(42.3 卤6.8) mm vs (31.7 卤2.5) mm] was significantly different (t = 2.99 卤3.38 卤6.32, respectively). The area under the curve for diagnosis of ischemic stroke with atrial fibrillation was 0.801, the best cut-off point was STAF 鈮，

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