【摘要】：目的探討心房顫動篩查評分(STAF)和包括左心房直徑(L)、年齡(A)、卒中/短暫性腦缺血發(fā)作(D)、發(fā)病前1年吸煙(S)4個指標(biāo)的LADS評分以及包括年齡、美國國立衛(wèi)生研究院卒中量表(NIHSS)評分、左心房擴大及血管病因4個指標(biāo)的ASAS評分3種方法在缺血性卒中合并心房顫動患者篩查中的臨床應(yīng)用價值。方法回顧性分析2016年4月至2017年4月于廣州醫(yī)科大學(xué)附屬第二醫(yī)院神經(jīng)內(nèi)科住院的急性缺血性卒中患者317例的臨床及影像學(xué)資料,依據(jù)患者是否合并心房顫動分為房顫組(56例)和非房顫組(261例),收集患者的性別、年齡、既往史、NIHSS評分、超聲心動圖結(jié)果及腦血管評估情況等相關(guān)臨床資料,對所有患者分別進行STAF、LADS和ASAS評分,繪制受試者工作特征曲線(ROC),計算曲線下面積并比較3種方法預(yù)測缺血性卒中合并心房顫動發(fā)生的敏感度、特異度以及準(zhǔn)確度。結(jié)果房顫組與非房顫組患者比較,年齡[(69±11)歲比(62±12)歲]、NIHSS評分[(8.2±1.3)分比(4.4±0.3)分]、左心房內(nèi)徑[(42.3±6.8)mm比(31.7±2.5)mm]差異均有統(tǒng)計學(xué)意義(t值分別為2.99、3.38、6.32,均P0.01)。STAF評分診斷缺血性卒中合并心房顫動的曲線下面積為0.801,最佳截斷點為STAF≥5分,敏感度為58.9%,特異度81.2%,準(zhǔn)確度77.3%;LADS評分診斷缺血性卒中合并心房顫動的曲線下面積為0.846,最佳截斷點為LADS≥4分,敏感度66.1%,特異度83.5%,準(zhǔn)確度80.4%;ASAS預(yù)測值評分診斷缺血性卒中合并心房顫動的曲線下面積為0.835,最佳截斷點為ASAS預(yù)測值≥0.09分,敏感度85.7%,特異度56.7%,準(zhǔn)確度61.8%;3種評分方法敏感度、特異度及準(zhǔn)確度差異均有統(tǒng)計學(xué)意義(χ2值分別為10.308、59.685、32.054,均P0.01)。結(jié)論 LADS≥4分在篩選急性缺血性卒中合并心房顫動中的準(zhǔn)確度最高。
[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 鹵11) years old vs (62 鹵12) years old, the NIHSS score was (8.2 鹵1.3) points vs (4.4 鹵0.3) years, and the age of patients with atrial fibrillation group was (69 鹵11) years old vs (62 鹵12) years old. The diameter of left atrium [(42.3 鹵6.8) mm vs (31.7 鹵2.5) mm] was significantly different (t = 2.99 鹵3.38 鹵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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