三种评分方法在缺血性卒中合并心房颤动筛查中的应用

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(f值分别为2.99、3.38、6.32,均P＜0.01).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(x2值分别为10.308、59.685、32.054,均P＜0.01). 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.%Objective To explore the clinical application values of the score for the targeting of atrial fibrillation (STAF) and left atrial diameter (L),age (A),diagnosis of stroke or TIA (D),and smoking one year before onset (S) (LADS) and acute stroke atrial fibrillation score (ASAS) (including 4 indicators:age,National Institutes of Health Stroke Scale [NIHSS] score,left atrial enlargement,and vascular etiology) in the screening of patients with ischemic stroke complicated with atrial fibrillation.Methods From April 2016 to April 2017,the clinical and imaging data of 317 patients with acute ischemic stroke admitted to the Department of Neurology,the Second Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively.The patients were divided into either an atrial fibrillation group (n =56) or a non-atrial fibrillation group (n =261) according to whether they had atrial fibrillation or not.The relative clinical data including gender,age,past history,NIHSS score,echocardiographic results,and cerebrovascular assessment were collected.STAF,LADS,and ASAS scores were performed in all patients,the receiver operating characteristic (ROC) curve was drawn,the area under the curve was calculated,and the sensitivity,specificity,and accuracy of the 3 methods for predicting ischemic stroke with atrial fibrillation were compared.Results Compared with the non-atrial fibrillation group,the differences were statistically significant in age (69 ± 11 years vs.62 ± 12 years),NIHSS scores (8.2 ± 1.3 vs.4.4 ± 0.3),and internal diameter of left atrium (42.3 ± 6.8 mm vs.31.7 ± 2.5 mm) in the atrial fibrillation group (t =2.99,3.38,and 6.32,respectively,all P ＜ 0.01).The area under the curve of STAF score for the diagnosis of ischemic stroke complicated with atrial fibrillation was 0.801.The optimal cut-off point was STAF ≥5,the sensitivity was 58.9％,specificity was 81.2％,and accuracy was 77.3％.The area under the curve of LADS score for diagnosis of atrial fibrillation was 0.846,the optimal cut-off point was LADS ≥ 4,the sensitivity was 66.1％,specificity 83.5 ％,and accuracy was 80.4％.The area under the curve of pr (ASAS) score for diagnosis of ischemic stroke complicated with atrial fibrillation was 0.835,the optimal cut-off point was pr (ASAS) ≥0.09,the sensitivity was 85.7％,specificity 56.7％,and accuracy was 61.8％.The sensitivity,specificity and accuracy of the three scoring methods were statistically significant (x2 =10.308,59.685,and 32.054,respectively,all P ＜ 0.01).Conclusion The accuracy of LADS ≥ 4 is the highest in screening of acute ischemic stroke complicated with atrial fibrillation