于琦,庄梅
YU Qi,ZHUANG Mei

• 1:贵阳市第一人民医院心内科
• 2:贵州医科大学附院心内科

摘要(Abstract)：

目的:探讨CHADS_2、CHA_2DS_2-VAS_C及HAS-BLED评分评估老年非瓣膜病房颤(AF)患者华法林抗凝治疗中优缺点。方法:100例老年非瓣膜病AF患者分为65～74岁组(n=65)及≥75岁组(n=35),分别采用CHADS_2及CHA_2DS_2-VAS_C评分评估卒中风险、HAS-BLED评分评估出血风险; CHADS_2评分中的中、高危患者予华法林抗凝治疗,随访(1±0.2)年,比较两种卒中评分系统危险分层的差异及不良事件的发生情况。结果:与CHADS_2评分相比,CHA_2DS_2-VAS_C评分系统的中、高危组患者比例明显增高,低危组患者比例降低(P<0.001);随访期间,卒中事件主要发生在CHADS_2评分的低危组(P<0.05),出血事件主要发生在HAS-BLED评分≥3分的人群(P<0.001),"双向事件"(血栓及出血事件)主要发生在≥75岁组(P<0.001)。结论:CHA_2DS_2-VAS_C在我国老年非瓣膜病AF患者卒中风险的评估中更优,结合HAS-BLED评分可降低华法林治疗的出血风险。
Objective:To explore the value of CHADS_2,CHA_2DS_2-VASc and HAS-BLED scores in evaluating risk of infarction or hemorrhage in elderly patients with non-valvular atrial fibrillation(AF)who uses warfarin.Methods:A total of 100 elderly patients with non-valvular AF were divided into 65～74 years old group(n=65) and over 75 years old group(n=35).The risk of stroke was assessed by CHADS_2 and CHA_2DS_2-VAS_C scores,and the risk of bleeding was assessed by HAS-BLED score.The medium and high risk patients in CHADS_2 score were treated with warfarin.Following up for(1 +0.2) years,the difference of risk stratification between the two stroke scoring systems and the occurrence of adverse events were compared.Results:Compared with CHADS_2 scoring system,the proportion of medium and high-risk group patients of CHA_2DS_2-VAS_C scoring system significantly increased,while the proportion of low-risk group patients decreased(P<0.001);During the follow-up period,stroke events mainly occurred in low-risk group of CHADS_2 score system(P<0.05);Bleeding events mainly occurred in group with HAS-BLED score system over 3 points(P<0.001);Thrombosis and bleeding events occurred mainly in the age of 75 or higher group(P<0.001).Conclusions:CHA_2DS_2-VAS_C is better in stroke risk assessment of elderly non-valvular AF patients in China.Combining HAS-BLED score can reduce the risk of bleeding in warfarin treatment.

关键词(KeyWords)： 心房颤动;CHADS2评分;CHA2DS2-VASC评分;HAS-BLED评分;华法林
atrial fibrillation;CHADS2 scoring system;CHA2DS2-VASC scoring system;HASBLED scoring system;warfarin

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅[黔科合(2010)316]

作者(Author): 于琦,庄梅
YU Qi,ZHUANG Mei

DOI: 10.19367/j.cnki.1000-2707.2019.01.021

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