Li Wenjie, Zeng Xiaojun, Xu Lingling, Wang Tao, Lin Weiyi, Li Yuanqing, Luo Yan, Luo Bihui
Nanshan College, Guangzhou Medical University, Guangzhou, China; The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ann Palliat Med. 2020 Nov;9(6):4252-4261. doi: 10.21037/apm-20-297. Epub 2020 Nov 10.
Recent studies have demonstrated the limitations of the CHA2DS2-VASc score [congestive heart failure, hypertension, age (>65 years =1 point; >75 years =2 points), diabetes, and previous stroke/ transient ischemic attack (2 points), vascular disease] which lacks many of less common risk factors for stroke. Moreover, only two risk factors, gender and age, are assigned with different points according to the stratification in the CHA2DS2-VASc score. Thus, this meta-analysis was aimed to optimize the stratification of risk factors in and beyond the CHA2DS2-VASc score for patients in mainland China. PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Journal Database (VIP) were searched from their inception to January 2020 for articles assessing risk factors of nonvalvular atrial fibrillation (NVAF) with ischemic stroke in mainland China. Odd risks (ORs) with 95% confidence intervals (CIs) were applied for dichotomous variable, and the weighed mean differences (WMDs) with standard deviations (SDs) were used for continuous variables. The meta-analysis included 20 eligible studies involving 14,675 patients. Compared with the non-stroke group [systolic blood pressure (SBP): 132.99 mmHg, 95% CI: 131.86-134.12; diastolic blood pressure (DBP): 80.08 mmHg, 95% CI: 78.63-81.53], the ischemic stroke group (SBP:144.07 mmHg, 95% CI: 140.74- 147.40; DBP: 84.41 mmHg, 95% CI: 82.39-86.43) showed increased levels of SBP (WMD 10.98 mmHg, 95% CI: 7.80-14.17, P<0.00001) and DBP (WMD 4.46 mmHg, 95% CI: 2.57-6.35, P<0.00001). In addition, the ischemic stroke group demonstrated significantly lower levels of left ventricular ejection fractions (LVEFs) (WMD 3.05% 95% CI: -5.96 to -0.14, P=0.04), and significantly higher levels of total cholesterol (TC) (WMD 0.32 mmol/L, 95% CI: 0.04-0.61, P=0.02) and low density lipoprotein cholesterol (LDL-C) (WMD 0.14 mmol/L, 95% CI: 0.02-0.26, P=0.02), as compared with the non-stroke group. The optimized stratification and the addition of risk factors in and beyond the CHA2DS2-VASc score may improve the predictive performance, thus helping to differentiate patients with the real thromboembolic risk.
近期研究已证实了CHA2DS2-VASc评分[充血性心力衰竭、高血压、年龄（>65岁=1分；>75岁=2分）、糖尿病以及既往卒中/短暂性脑缺血发作（2分）、血管疾病]的局限性，该评分缺乏许多不太常见的卒中危险因素。此外，在CHA2DS2-VASc评分中，只有性别和年龄这两个危险因素根据分层被赋予了不同分值。因此，本荟萃分析旨在优化中国大陆患者CHA2DS2-VASc评分内外的危险因素分层。检索了PubMed、Embase、Web of Science、Cochrane图书馆、中国知网（CNKI）和中国科技期刊数据库（维普）自建库至2020年1月期间评估中国大陆非瓣膜性心房颤动（NVAF）合并缺血性卒中危险因素的文章。二分类变量采用具有95%置信区间（CI）的比值比（OR），连续变量采用具有标准差（SD）的加权均数差（WMD）。该荟萃分析纳入了20项符合条件的研究，涉及14,675例患者。与非卒中组[收缩压（SBP）：132.99 mmHg，95%CI：131.86 - 134.12；舒张压（DBP）：80.08 mmHg，95%CI：78.63 - 81.53]相比，缺血性卒中组（SBP：144.07 mmHg，95%CI：140.74 - 147.40；DBP：84.41 mmHg，95%CI：82.39 - 86.43）的SBP水平升高（WMD 10.98 mmHg，95%CI：7.80 - 14.17，P<0.00001），DBP水平升高（WMD 4.46 mmHg，95%CI：2.57 - 6.35，P<0.00001）。此外，与非卒中组相比，缺血性卒中组的左心室射血分数（LVEF）水平显著降低（WMD 3.05%，95%CI：-5.96至-0.14，P = 0.04），总胆固醇（TC）水平显著升高（WMD 0.32 mmol/L，95%CI：0.04 - 0.61，P = 0.02），低密度脂蛋白胆固醇（LDL-C）水平显著升高（WMD 0.14 mmol/L，95%CI：0.02 - 0.26，P = 0.02）。CHA2DS2-VASc评分内外危险因素的优化分层及增加可能会改善预测性能，从而有助于区分真正有血栓栓塞风险的患者。
