iPAB和STAF评分系统对急性缺血性脑卒中患者发生阵发性心房颤动的预测价值
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摘要
目的评估i PAB和STAF评分系统在急性缺血性脑卒中患者阵发性心房颤动(PAF)筛查中的价值。方法对2015年10月至2017年10月就诊于云南省第一人民医院的连续性急性缺血性脑卒中患者进行了前瞻性队列研究,共招募了469例缺血性脑卒中患者,其中74例(15. 8%)患者被发现患有PAF。基线美国国立卫生研究院卒中量表(NIHSS)评分、左心房扩大和血管病因学被评估以计算STAF评分;心律失常或抗心律失常既往史、左心房扩大和B型脑钠肽水平被调查以计算i PAB评分。使用多因素Logistic回归分析PAF与i PAB、STAF各因素之间的关系。采用受试者工作特征(ROC)曲线确定i PAB、STAF用于筛查PAF的诊断价值。结果 Logistic多因素分析结果显示,年龄(比值比=1. 039,95%置信区间:1. 007～1. 069),左心房扩大(比值比=1. 208,95%置信区间:1. 150～1. 282),基线NIHSS评分(比值比=1. 138,95%置信区间:1. 091～1. 203),缺乏血管病因学证据(比值比=0. 167,95%置信区间:0. 083～0. 336),心律失常史或使用抗心律失常药物(比值比=1. 165,95%置信区间:1. 076～1. 225)以及B型脑钠肽水平升高(比值比=1. 076,95%置信区间:1. 015～1. 140)是缺血性脑卒中患者发生PAF的危险因素(均P <0. 01)。ROC曲线分析显示,STAF评分≥5分与i PAB评分≥4分被认为是PAF的相关危险因素,STAF的特异度与敏感度分别为78. 0%、76. 0%,i PAB的特异度与敏感度分别为95. 0%与82. 0%,i PAB预测PAF的特异度与敏感度均优于STAF(均P <0. 05); STAF与i PAB的ROC曲线下面积分别为0. 81、0. 93,二者比较差异有统计学意义(P <0. 05)。结论 i PAB评分系统预测急性缺血性脑卒中发生PAF的高危患者的性能优于STAF评分系统,且简单而易于使用。
Objective To evaluate the i PAB and STAF scoring systems for screening paroxysmal atrial fibrillation( PAF) in patients with acute ischemic stroke. Methods Totally 469 cases of acute ischemic stroke were enrolled from October 2015 to October 2017 in the First People's Hospital of Yunnan Province. Among them,74 patients( 15. 8%) was diagnosed of PAF. National Institutes of Health Stroke Scale( NIHSS),left atrial dilatation and vascular etiology were assessed to calculate STAF score. Arrhythmia or antiarrhythmic history,left atrial diameter and brain natriuretic peptide( BNP) level were assessed to calculate i PAB score. Correlations among PAF,i PAB and STAF were analyzed by multivariate logistic regression. Diagnostic values of i PAB and STAF were analyzed by receiver operating characteristic( ROC) curve. Results Logistic regression analysis showed that age( odds ratio = 1. 039,95% confidence interval: 1. 007-1. 069),left atrial dilatation( odds ratio = 1. 208,95% confidence interval: 1. 150-1. 282),baseline NIHSS score( odds ratio = 1. 138,95% confidence interval:1. 091-1. 203),lack of vascular etiology( odds ratio = 0. 167,95% confidence interval: 0. 083-0. 336),arrhythmia or antiarrhythmic history( odds ratio = 1. 165,95% confidence interval: 1. 076-1. 225) and elevated BNP level( odds ratio = 1. 076,95% confidence interval: 1. 015-1. 140) were risk factors of PAF( all P < 0. 01). ROC curve showed that STAF score≥5( specificity = 78. 0%,sensitivity = 76. 0%) and i PAB score≥4( specificity =95. 0%,sensitivity = 82. 0%) indicated high risk of PAF and the diagnostic efficiency of i PAB is significantly higher than that of STAF( P < 0. 05); the area under ROC curve of i PAB( 0. 93) was larger than that of STAF( 0. 81)( P < 0. 05). Conclusion Compared with STAF,i PAB scoring system is a simple,easy-to-use and effective method to predict the risk of PAF in patients with acute ischemic stroke.
Objective To evaluate the i PAB and STAF scoring systems for screening paroxysmal atrial fibrillation( PAF) in patients with acute ischemic stroke. Methods Totally 469 cases of acute ischemic stroke were enrolled from October 2015 to October 2017 in the First People's Hospital of Yunnan Province. Among them,74 patients( 15. 8%) was diagnosed of PAF. National Institutes of Health Stroke Scale( NIHSS),left atrial dilatation and vascular etiology were assessed to calculate STAF score. Arrhythmia or antiarrhythmic history,left atrial diameter and brain natriuretic peptide( BNP) level were assessed to calculate i PAB score. Correlations among PAF,i PAB and STAF were analyzed by multivariate logistic regression. Diagnostic values of i PAB and STAF were analyzed by receiver operating characteristic( ROC) curve. Results Logistic regression analysis showed that age( odds ratio = 1. 039,95% confidence interval: 1. 007-1. 069),left atrial dilatation( odds ratio = 1. 208,95% confidence interval: 1. 150-1. 282),baseline NIHSS score( odds ratio = 1. 138,95% confidence interval:1. 091-1. 203),lack of vascular etiology( odds ratio = 0. 167,95% confidence interval: 0. 083-0. 336),arrhythmia or antiarrhythmic history( odds ratio = 1. 165,95% confidence interval: 1. 076-1. 225) and elevated BNP level( odds ratio = 1. 076,95% confidence interval: 1. 015-1. 140) were risk factors of PAF( all P < 0. 01). ROC curve showed that STAF score≥5( specificity = 78. 0%,sensitivity = 76. 0%) and i PAB score≥4( specificity =95. 0%,sensitivity = 82. 0%) indicated high risk of PAF and the diagnostic efficiency of i PAB is significantly higher than that of STAF( P < 0. 05); the area under ROC curve of i PAB( 0. 93) was larger than that of STAF( 0. 81)( P < 0. 05). Conclusion Compared with STAF,i PAB scoring system is a simple,easy-to-use and effective method to predict the risk of PAF in patients with acute ischemic stroke.
引文
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[12]袁振华,关景霞,卢祖能.STAF及LADS评分筛查急性缺血性脑卒中患者合并心房颤动的临床研究[J].卒中与神经疾病,2016,23(1):21-25.DOI:10.3969/j.issn.1007-0478.2016.01.006.Yuan ZH,Guan JX,Lu ZN.STAF and LADS score for screening atrial fibrillation in patients with acute ischemic stroke:a clinical research[J].Stroke and Nervous Diseases,2016,23(1):21-25.DOI:10.3969/j.issn.1007-0478.2016.01.006.
[13]张蕾,曹秉振.STAF及LADS评分对急性缺血性脑卒中患者心房颤动预测价值研究[J].陕西医学杂志,2017,46(8):1034-1036.DOI:10.3969/j.issn.1000-7377.2017.08.022.Zhang L,Cao BZ.Predictive values of STAF and LADS score for atrial fibrillation in patients with acute ischemic stroke[J].Shaanxi Medical Journal,2017,46(8):1034-1036.DOI:10.3969/j.issn.1000-7377.2017.08.022.
[14]Figueiredo MMD,Rodrigues ACT,Alves MB,et al.Score for atrial fibrillation detection in acute stroke and transient ischemic attack patients in a Brazilian population:the acute stroke atrial fibrillation scoring system[J].Clinics(Sao Paulo),2014,69(4):241-246.DOI:10.6061/clinics/2014(04)04.
[15]彭玉华,林峰,王永红.STAF评分对房颤导致心源性脑梗死的诊断价值[J].山东医药,2015,55(29):49-50.DOI:10.3969/j.issn.1002-266X.2015.29.019.Peng YH,Lin F,Wang YH.Diagnostic value of STAF score for cardiogenic cerebral infarction caused by atrial fibrillation[J].Shandong Medical Journal,2015,55(29):49-50.DOI:10.3969/j.issn.1002-266X.2015.29.019.
[16]Ricci B,Chang AD,Hemendinger M,et al.A simple score that predicts paroxysmal atrial fibrillation on outpatient cardiac monitoring after embolic stroke of unknown source[J].J Stroke Cerebrovasc Dis,2018,27(6):1692-1696.DOI:10.1016/j.jstrokecerebrovasdis.2018.01.028.
[17]梁睿,马翰章,林冰.三种评分方法在缺血性卒中合并心房颤动筛查中的应用[J].中国脑血管病杂志,2017,14(11):566-570.DOI:10.3969/j.issn.1672-5921.2017.11.002.Liang R,Ma HZ,Lin B.Application of three scoring methods in screening of ischemic stroke complicated with atrial fibrillation[J].Chinese Journal of Cerebrovascular Diseases,2017,14(11):566-570.DOI:10.3969/j.issn.1672-5921.2017.11.002.
[18]Todo K,Ishii J,Kono T,et al.Delayed elevation of plasma brain natriuretic peptide as a cue to diagnosis of atrial fibrillation in cryptogenic stroke:a case report[J].J Neurol Sci,2017(381):16-18.DOI:10.1016/j.jns.2017.08.003.
[19]Maruyama K,Uchiyama S,Shiga T,et al.Brain natriuretic peptide is a powerful predictor of iutcome in stroke patients with atrial fibrillation[J].Cerebrovasc Dis Extra,2017,7(1):35-43.DOI:10.1159/000457808.
[2]Del-Carpio Munoz MF,Yao X,Abraham NS,et al.Dabigatran versus warfarin in relation to renal function in patients with atrial fibrillation[J].J Am Coll Cardiol,2016,68(1):129-131.DOI:10.1016/j.jacc.2016.04.031.
[3]Wu B,Li K,Liu X,et al.Cost-effectiveness of different strategies for stroke prevention in patients with atrial fibrillation in a health resource-limited setting[J].Cardiovasc Drugs Ther,2014,28(1):87-98.DOI:10.1007/s10557-013-6490-9.
[4]邱樑,项美香,王建安.家庭远程监测系统在心脏植入型电子器械中的应用[J].中华心血管病杂志,2016,44(1):55-59.DOI:10.3760/cma.j.issn.0253-3758.2016.01.012.Qiu L,Xiang MX,Wang JA.Experiences of applying home monitoring for cardiac implantable electronic devices[J].Chinese Journal of Cardiology,2016,44(1):55-59.DOI:10.3760/cma.j.issn.0253-3758.2016.01.012.
[5]Berntsson J,Zia E,BornéY,et al.Plasma natriuretic peptides and incidence of subtypes of ischemic stroke[J].Cerebrovasc Dis,2014,37(6):444-450.DOI:10.1159/000363279.
[6]Liu XY,Li YX,Fu YG,et al.The value of the score for the targeting of atrial fibrillation(STAF)screening in acute stroke patients[J].J Stroke Cerebrovasc Dis,2017,26(6):1280-1286.DOI:10.1016/j.jstrokecerebrovasdis.2017.01.022.
[7]孙红梅,赵莉,李飞,等.非瓣膜性心房颤动合并缺血性卒中患者左心房指数与卒中复发风险的相关性研究[J].临床内科杂志,2018,35(10):676-680.DOI:10.3969/j.issn.1001-9057.2018.10.008.Sun HM,Zhao L,Li F,et al.Relationship of left atrial index and risk of stroke recurrence in patients with nonvalvular atrial fibrillation and ischemic stroke[J].Journal of Clinical Internal Medicine,2018,35(10):676-680.DOI:10.3969/j.issn.1001-9057.2018.10.008.
[8]陈晓丽,庞兴学,樊燕琴,等.老年心房颤动患者合并缺血性脑卒中相关危险因素分析[J].中国医药,2015,10(9):1268-1270.DOI:10.3760/cma.j.issn.1673-4777.2015.09.006.Chen XL,Pang XX,Fan YQ,et al.Related factors of ischemic stroke in elderly patients with atrial fibrillation[J].China Medicine,2015,10(9):1268-1270.DOI:10.3760/cma.j.issn.1673-4777.2015.09.006.
[9]Fuster V,Rydén LE,Cannom DS,et al.ACC/AHA/ESC 2006Guidelines for the Management of Patients with Atrial Fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines(Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society[J].Circulation,2006,114(7):e257-354.DOI:10.1161/CIRCULATIONAHA.106.177292.
[10]Chapman CB,Ewer SM,Kelly AF,et al.Classification of left ventricular diastolic function using American Society of Echocardiography Guidelines:agreement among echocardiographers[J].Echocardiography,2013,30(9):1022-1031.DOI:10.1111/echo.12185.
[11]Fransen PS,Berkhemer OA,Lingsma HF,et al.Time to reperfusion and treatment effect for acute ischemic stroke:a randomized clinical trial[J].JAMA Neurol,2016,73(2):190-196.DOI:10.1001/jamaneurol.2015.3886.
[12]袁振华,关景霞,卢祖能.STAF及LADS评分筛查急性缺血性脑卒中患者合并心房颤动的临床研究[J].卒中与神经疾病,2016,23(1):21-25.DOI:10.3969/j.issn.1007-0478.2016.01.006.Yuan ZH,Guan JX,Lu ZN.STAF and LADS score for screening atrial fibrillation in patients with acute ischemic stroke:a clinical research[J].Stroke and Nervous Diseases,2016,23(1):21-25.DOI:10.3969/j.issn.1007-0478.2016.01.006.
[13]张蕾,曹秉振.STAF及LADS评分对急性缺血性脑卒中患者心房颤动预测价值研究[J].陕西医学杂志,2017,46(8):1034-1036.DOI:10.3969/j.issn.1000-7377.2017.08.022.Zhang L,Cao BZ.Predictive values of STAF and LADS score for atrial fibrillation in patients with acute ischemic stroke[J].Shaanxi Medical Journal,2017,46(8):1034-1036.DOI:10.3969/j.issn.1000-7377.2017.08.022.
[14]Figueiredo MMD,Rodrigues ACT,Alves MB,et al.Score for atrial fibrillation detection in acute stroke and transient ischemic attack patients in a Brazilian population:the acute stroke atrial fibrillation scoring system[J].Clinics(Sao Paulo),2014,69(4):241-246.DOI:10.6061/clinics/2014(04)04.
[15]彭玉华,林峰,王永红.STAF评分对房颤导致心源性脑梗死的诊断价值[J].山东医药,2015,55(29):49-50.DOI:10.3969/j.issn.1002-266X.2015.29.019.Peng YH,Lin F,Wang YH.Diagnostic value of STAF score for cardiogenic cerebral infarction caused by atrial fibrillation[J].Shandong Medical Journal,2015,55(29):49-50.DOI:10.3969/j.issn.1002-266X.2015.29.019.
[16]Ricci B,Chang AD,Hemendinger M,et al.A simple score that predicts paroxysmal atrial fibrillation on outpatient cardiac monitoring after embolic stroke of unknown source[J].J Stroke Cerebrovasc Dis,2018,27(6):1692-1696.DOI:10.1016/j.jstrokecerebrovasdis.2018.01.028.
[17]梁睿,马翰章,林冰.三种评分方法在缺血性卒中合并心房颤动筛查中的应用[J].中国脑血管病杂志,2017,14(11):566-570.DOI:10.3969/j.issn.1672-5921.2017.11.002.Liang R,Ma HZ,Lin B.Application of three scoring methods in screening of ischemic stroke complicated with atrial fibrillation[J].Chinese Journal of Cerebrovascular Diseases,2017,14(11):566-570.DOI:10.3969/j.issn.1672-5921.2017.11.002.
[18]Todo K,Ishii J,Kono T,et al.Delayed elevation of plasma brain natriuretic peptide as a cue to diagnosis of atrial fibrillation in cryptogenic stroke:a case report[J].J Neurol Sci,2017(381):16-18.DOI:10.1016/j.jns.2017.08.003.
[19]Maruyama K,Uchiyama S,Shiga T,et al.Brain natriuretic peptide is a powerful predictor of iutcome in stroke patients with atrial fibrillation[J].Cerebrovasc Dis Extra,2017,7(1):35-43.DOI:10.1159/000457808.