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中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (02) : 69 -75. doi: 10.3877/cma.j.issn.2095-9141.2022.02.002

临床研究

CHA2DS2-VASc评分在高血压合并冠心病患者脑卒中风险预测中的应用
庞慧1, 杨浩1, 付强1, 郭鹏2, 纵振坤2,()   
  1. 1. 221009 徐州市中心医院心内科(南京医科大学徐州临床医学院)
    2. 221002 徐州,徐州医科大学附属医院神经外科
  • 收稿日期:2021-06-03 出版日期:2022-04-15
  • 通信作者: 纵振坤
  • 基金资助:
    江苏省自然科学基金(BK20190158); 江苏省第五期"333工程"(BRA2019239); 江苏省第十五批"六大人才高峰"高层次人才项目(WSN270); 江苏省青年医学人才项目(QNRC2016383); 徐州市社会发展项目(KC19026)

Application of CHA2DS2-VASc score in stroke risk prediction in patients with hypertension and coronary heart disease

Hui Pang1, Hao Yang1, Qiang Fu1, Peng Guo2, Zhenkun Zong2,()   

  1. 1. Department of Cardiology, Xuzhou Central Hospital (The Xuzhou School of Clinical Medicine of Nanjing Medical University), Xuzhou 221009, China
    2. Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
  • Received:2021-06-03 Published:2022-04-15
  • Corresponding author: Zhenkun Zong
引用本文:

庞慧, 杨浩, 付强, 郭鹏, 纵振坤. CHA2DS2-VASc评分在高血压合并冠心病患者脑卒中风险预测中的应用[J/OL]. 中华神经创伤外科电子杂志, 2022, 08(02): 69-75.

Hui Pang, Hao Yang, Qiang Fu, Peng Guo, Zhenkun Zong. Application of CHA2DS2-VASc score in stroke risk prediction in patients with hypertension and coronary heart disease[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(02): 69-75.

目的

探讨CHA2DS2-VASc评分对于高血压合并冠心病患者脑卒中发生风险的预测价值。

方法

纳入徐州市中心医院与徐州医科大学附属医院自2019年3月至2020年12月收治的3555例确诊为高血压合并冠心病的患者,依据其临床基线资料计算出CHA2DS2-VASc评分。采用Logistic回归模型分析血压水平与脑卒中各危险因素之间的交互作用,采用受试者工作特征曲线下面积(AUC)判定CHA2DS2-VASc评分对于高血压合并冠心病患者发生脑卒中的预测价值。

结果

年龄、女性占比,合并疾病中糖尿病、心力衰竭、脑卒中/短暂性脑缺血发作、血管疾病、心房颤动患病率均随血压水平升高而增加(P<0.05)。CHA2DS2-VASc评分与血压水平、NYHA心功能分级均呈正相关关系(P<0.05)。男性、合并糖尿病或心力衰竭、CHA2DS2-VASc评分≥5分的血压水平较高患者更易于罹患脑卒中(P<0.05)。CHA2DS2-VASc评分预测3555例高血压合并冠心病患者脑卒中风险的AUC为0.923(95%CI:0.910~0.936,P<0.001),其中2603例男性患者AUC为0.938(95%CI:0.926~0.951,P<0.001),952例女性患者AUC为0.921(95%CI:0.898~0.945,P<0.001)。

结论

CHA2DS2-VASc评分对于高血压合并冠心病患者脑卒中风险预测价值良好,鉴于女性脑卒中危险因素的多样性与复杂性,导致该评分预测价值的性别差异。

Objective

To explore the predictive value of CHA2DS2-VASc or the risk of stroke in patients with hypertension and coronary heart disease (CHD).

Methods

Among the 3555 patients diagnosed with hypertension and coronary heart disease admitted to Xuzhou Central Hospital and the Affiliated Hospital of Xuzhou Medical University from March 2019 to December 2020, the CHA2DS2-VASc score was calculated based on their clinical baseline data. Interactions between blood pressure level and risk factors of stroke were assessed using Logistic regression model. The area under the curve (AUC) of the receiver operating characteristic was used to determine the predictive value of CHA2DS2-VASc score for stroke in patients with hypertension and CHD.

Results

The higher blood pressure was association with increased age, proportion of women and prevalence of complications, such as diabetes, heart failure, stroke/transient ischemic attack, vascular disease and atrial fibrillation classification (P<0.05). CHA2DS2-VASc score was positively correlated with blood pressure and NYHA functional classification (P<0.05). Men, patients with diabetes or heart failure, and CHA2DS2-VASc score≥5 were more likely to develop stroke (P<0.05). The AUC of stroke risk perdicted with CHA2DS2-VASc score was 0.923 (95%CI: 0.910-0.936, P<0.001) in 3555 patients with hypertension and CHD, among which, AUC was 0.938 (95%CI: 0.926-0.951, P<0.001) in 2603 male patients and 0.921 (95%CI: 0.898-0.945, P<0.001) in 952 female patients.

Conclusion

The CHA2DS2-VASc score has excellent predictive value for stroke risk in patients with hypertension and combined with CHD. There are sex differences in the predictive value of the CHA2DS2-VASc score due to the diversity and complexity of stroke risk factors in female patients.

表1 不同级别高血压合并冠心病患者基线资料比较
项目 高血压1级组(n=1168) 高血压2级组(n=1206) 高血压3级组(n=1181) F/H P
年龄(岁,Mean±SD) 59.02±10.48 60.91±10.39a 62.31±10.42ab 29.546 <0.001
年龄亚组[例(%)]       39.048 <0.001
  ≤64 790(67.64) 751(62.27)a 654(55.38)ab 37.574 <0.001
  65~74 297(25.43) 336(27.86) 393(33.28)ab 18.504 <0.001
  ≥75 81(6.93) 119(9.87)a 134(11.35)a 13.899 0.001
女性[例(%)] 249(21.32) 300(24.88)a 403(34.12)a 52.465 <0.001
合并疾病[例(%)]          
  糖尿病 312(26.71) 388(32.17)a 408(34.55)a 17.656 <0.001
  心力衰竭       10.733 0.005
    NYHA Ⅰ级 228(19.52) 228(18.91) 225(19.05) 0.157 0.924
    NYHA Ⅱ级 117(10.02) 167(13.85)a 137(11.60) 8.435 0.015
    NYHA Ⅲ级 33(2.83) 43(3.57) 65(5.50)ab 11.827 0.003
    NYHA Ⅳ级 7(0.60) 13(1.08) 17(1.44) 4.048 0.132
  脑卒中/TIA 68(5.82) 109(9.04)a 138(11.69)a 25.061 <0.001
  血管疾病 287(24.57) 328(27.20) 346(29.30)a 6.671 0.036
  高脂血症 772(66.10) 708(58.71)a 658(55.72)a 27.954 <0.001
  心房颤动 37(3.17) 59(4.89)a 94(7.96)ab 27.381 <0.001
CHA2DS2-VASc评分[例(%)] 2(2,3) 3(2,4)a 3(2,4)ab 78.676 <0.001
  1 276(23.63) 226(18.74)a 201(17.02)a 17.404 <0.001
  2 356(30.48) 310(25.70)a 242(20.49)ab 30.823 <0.001
  3 275(23.54) 324(26.87) 295(24.98) 3.503 0.174
  4 154(13.18) 179(14.84) 212(17.95)a 10.608 0.005
  ≥5 107(9.16) 167(13.85)a 231(19.56)ab 52.280 <0.001
图1 高血压和性别、糖尿病、心力衰竭、CHA2DS2-VASc评分对于脑卒中风险的交互作用
表2 血压对于高血压合并冠心病患者脑卒中风险的影响
项目 高血压1级组 高血压2级组 高血压3级组 交互P
卒中率[例(%)] OR(95%CI) 卒中率[例(%)] OR(95%CI) 卒中率[例(%)] OR(95%CI)
年龄(岁)             0.697
  ≤64 32(4.05) Ref 53(7.06) 1.616(1.022~2.556) 54(8.26) 1.868(1.180~2.959)  
  65~74 30(10.10) Ref 36(10.71) 1.019(0.604~1.719) 59(15.01) 1.394(0.855~2.271)  
  ≥75 6(7.41) Ref 20(16.81) 2.978(1.051~8.440) 25(18.66) 3.340(1.217~9.162)  
性别             0.004
  49(5.33) Ref 82(9.05) 1.566(1.073~2.286) 94(12.08) 2.095(1.442~3.043)  
  19(7.63) Ref 27(9.00) 1.097(0.585~2.056) 44(10.92) 1.137(0.630~2.052)  
糖尿病             0.003
  50(5.84) Ref   1.307(0.887~1.928) 71(9.18) 1.365(0.924~2.015)  
  18(5.77) Ref 43(11.08) 1.770(0.984~3.182) 67(16.42) 2.825(1.612~4.952)  
心力衰竭             <0.001
  35(4.47) Ref 53(7.02) 1.484(0.951~2.317) 63(8.55) 1.738(1.122~2.692)  
               
    NYHA Ⅰ级 15(6.58) Ref 18(7.89) 1.138(0.550~2.358) 30(13.33) 2.005(1.024~3.928)  
    NYHA Ⅱ级 11(9.40) Ref 26(15.57) 1.716(0.805~3.656) 22(16.06) 1.702(0.773~3.747)  
    NYHA Ⅲ/Ⅳ级 7(17.50) Ref 12(21.43) 1.136(0.383~3.370) 23(28.05) 1.620(0.591~4.442)  
血管疾病             0.785
  45(5.11) Ref 63(7.18) 1.320(0.882~1.974) 81(9.70) 1.799(1.217~2.660)  
  23(8.01) Ref 46(14.02) 1.556(0.905~2.674) 57(16.47) 1.763(1.034~3.004)  
高脂血症             0.948
  22(5.56) Ref 46(9.24) 1.555(0.907~2.666) 60(11.47) 1.899(1.123~3.213)  
  46(5.96) Ref 63(8.90) 1.331(0.889~1.993) 78(11.85) 1.675(1.127~2.488)  
心房颤动             0.538
  63(5.57) Ref 101(8.81) 1.444(1.034~2.017) 125(11.50) 1.870(1.349~2.592)  
  5(13.51) Ref 8(13.56) 0.922(0.261~3.253) 13(13.83) 0.768(0.232~2.540)  
CHA2DS2-VASc评分             <0.001
  1~4分 24(2.26) Ref 32(3.08) 1.479(0.861~2.542) 28(2.95) 1.493(0.852~2.616)  
  ≥5分 44(41.12) Ref 77(46.11) 2.014(1.025~3.956) 110(47.62) 2.574(1.363~4.859)  
图2 CHA2DS2-VASc评分预测脑卒中风险的受试者工作特征曲线A:高血压合并冠心病;B:男性;C:女性
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