CHA2DS2-VASc评分、NIHSS评分联合NLR对非瓣膜性心房颤动合并急性脑梗死病人短期预后的预测价值

马博; 李理; 骆嵩; 李玉玉; 谢静; 许文芳; 刘晓林; 许力

doi:10.13898/j.cnki.issn.1000-2200.2023.04.010

CHA2DS2-VASc评分、NIHSS评分联合NLR对非瓣膜性心房颤动合并急性脑梗死病人短期预后的预测价值

Predictive value of CHA2DS2-VASc score, NIHSS score and neutrophil/lymphocyte ratio on short-term prognosis of patients with non-valvular atrial fibrillation complicated with acute cerebral infarction

摘要

摘要:
目的探讨CHA2DS2-VASc评分、基线NIHSS评分联合中性粒细胞/淋巴细胞比值(NLR)对非瓣膜性心房颤动(NVAF)合并急性脑梗死病人短期预后的预测价值。
方法连续纳入2018-2020年住院的NVAF合并急性脑梗死病人, 完整收集所有病人临床资料, 按照发病90 d后改良Rankin量表(mRS评分)将病人分为预后不良组和预后良好组, 比较2组相关资料的差异, 应用二分类logistic回归分析短期预后的独立影响因素, 并根据ROC曲线的结果评估CHA2DS2-VASc评分、基线NIHSS评分、NLR单个指标以及三者联合对NVAF合并急性脑梗死短期预后的预测价值。
结果共纳入238例病人, 其中预后不良组90例, 预后良好组148例。2组年龄、性别、合并肺部感染率、基线NIHSS评分、CHA2DS2-VASc评分、NLR、尿酸、C反应蛋白、纤维蛋白原差异均有统计学意义(P < 0.05~P < 0.01)。CHA2DS2-VASc评分、基线NIHSS评分和NLR均为NVAF合并急性脑梗死病人短期预后的独立影响因素(P < 0.05~P < 0.01)。三项指标及联合预测对NVAF合并急性脑梗死短期预后不良的ROC曲线下面积分别为0.816、0.885、0.726和0.932(P < 0.01)。
结论CHA2DS2-VASc评分、NIHSS评分联合NLR对NVAF合并急性脑梗死短期预后不良具有一定的预测价值, 可用于病人早期病情评估并进一步优化治疗策略。

Abstract:
ObjectiveTo explore the predictive value of CHA2DS2-VASc score, baseline NIHSS score and neutrophil/lymphocyte ratio (NLR) for short-term prognosis in patients with non-valvular atrial fibrillation (NVAF) complicated with acute cerebral infarction.
MethodsThe patients with NVAF complicated with acute cerebral infarction hospitalized from 2018 to 2020 were continuously included, and the clinical data of all patients were completely collected.The patients were divided into poor prognosis group and good prognosis group according to the modified Rankin scale (mRS score) 90 days after the onset of the disease.The differences in relevant data between the two groups were compared.The independent influencing factors for short-term prognosis were analyzed using binary logistic regression.The predictive value of CHA2DS2-VASc score, baseline NIHSS score, NLR single index and the combination of the three for short-term prognosis of NVAF complicated with acute cerebral infarction was evaluated by ROC curve.
ResultsA total of 238 patients were included in this study, including 90 patients in the poor prognosis group and 148 patients in the good prognosis group.There were statistically significant differences between the two groups in age, gender, combined pulmonary infection rate, baseline NIHSS score, CHA2DS2-VASc score, NLR, uric acid, C-reactive protein, and fibrinogen (P < 0.05 to P < 0.01).The CHA2DS2-VASc score, baseline NIHSS score, and NLR were independent influencing factors for short-term prognosis in patients with NVAF complicated with acute cerebral infarction (P < 0.05 to P < 0.01).The area under the ROC curve for short-term poor prognosis of NVAF complicated with acute cerebral infarction predicted by three indicators and their combination were 0.816, 0.885, 0.726, and 0.932, respectively (P < 0.01).
ConclusionsThe CHA2DS2-VASc score, NIHSS score and NLR have a certain predictive value for the short-term poor prognosis of NVAF patients complicated with acute cerebral infarction, which can be used to assess the patient's early condition and further optimize treatment strategies.

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