2021 年第 1 期 第 16 卷

可溶性生长刺激表达基因2蛋白联合CHA2DS2-VASc评分对非瓣膜性心房颤动患者急性脑梗死的预测价值

Predictive value of soluble growth stimulation expressed gene 2 protein combined with CHA2DS2-VASc score on acute cerebral embolism in patients with nonvalvular atrial fibrillation

作者：苏晴1蔡新宇1杨波2

英文作者：Su Qing1 Cai Xinyu1 Yang Bo2

单位：1陆军军医大学第二附属医院急诊科，重庆400037；2重庆市丰都县人民医院急诊医学科408200

英文单位：1Department of Emergency the Second Affiliated Hospital of Army Medical University Chongqing 400037 China; 2Department of Emergency Medicine People′s Hospital of Fengdu County Chongqing 408200 China 

关键词：非瓣膜性心房颤动；急性脑梗死；可溶性生长刺激表达基因2蛋白；CHA2DS2-VASc评分

英文关键词：Nonvalvularatrialfibrillation;Acutecerebralinfarction;Solublegrowthstimulationexpressedgene2protein;CHA2DS2-VAScscore

• 摘要：

• 目的 探讨可溶性生长刺激表达基因2蛋白（sST2）联合CHA2DS2-VASc评分对非瓣膜性心房颤动（NVAF）患者急性脑梗死的预测价值。方法 选取2015年3月至2016年2月于陆军军医大学第二附属医院就诊的239例NVAF患者作为研究对象。所有患者随访3年，其间失访3例，其余236例患者根据是否发生急性脑梗死事件将其分为脑梗死组（47例）和非脑梗死组（189例）。比较2组患者入组时一般资料、sST2水平、CHA2DS2-VASc评分及心脏彩色多普勒超声指标，分析NVAF患者急性脑梗死的危险因素及sST2、CHA2DS2-VASc评分的预测价值。结果 脑梗死组患者年龄、红细胞分布宽度、中性粒细胞与淋巴细胞比值（NLR）、平均血小板体积、纤维蛋白原、sST2水平、CHA2DS2-VASc评分、左心房内径均高于非脑梗死组，差异均有统计学意义（均P<0.05）。Cox多因素回归分析结果显示，年龄、NLR、平均血小板体积、纤维蛋白原、sST2和CHA2DS2-VASc评分是NVAF患者发生急性脑梗死的独立危险因素（均P<0.05）；Pearson相关性分析显示，sST2水平与CHA2DS2-VASc评分呈正相关（r=0.653，P<0.001）； sST2联合CHA2DS2-VASc评分预测NVAF患者急性脑梗死的受试者工作特征曲线下面积高于二者单独预测［0.926（95%置信区间0.886~0.967）比0.886（95%置信区间0.830~0.942）、0.887（95%置信区间0.843~0.931）］，差异均有统计学意义（Z=0.036、0.037，均P<0.001）。sST2、CHA2DS2-VASc评分预测NVAF患者急性脑梗死的截断值分别为159.7 μg/L、2分，以二者截断值将NVAF患者236例分为低危组（65例）、中危组（52例）、高危组（119例），Kaplan-Meier生存曲线显示，高危组NVAF患者发生急性脑梗死的风险高于低危组和中危组（Log-rank χ2=33.701、7.620，均P<0.001）。结论 sST2和CHA2DS2-VASc评分是NVAF患者发生急性脑梗死的独立危险因素，二者联合可提高对NVAF患者急性脑梗死的预测价值。

• Objective To explore the predictive value of soluble growth stimulation expressed gene 2 protein (sST2) combined with CHA2DS2-VASc score on acute cerebral infarction in patients with nonvalvular atrial fibrillation (NVAF). Methods A total of 239 patients with NVAF admitted to the Second Affiliated Hospital of Army Medical University from March 2015 to February 2016 were selected. All patients were followed-up for 3 years. During that period, 3 cases lost to follow-up, and the other 236 cases were divided into cerebral infarction group (47 cases) and non-cerebral infarction group (189 cases) according to whether acute cerebral infarction occurred. The general data, sST2 level, CHA2DS2-VASc score and cardiac color Doppler ultrasound indexes were compared between the two groups. The risk factors of acute cerebral infarction in NVAF patients and predictive value of sST2 and CHA2DS2-VASc score were analyzed. Results The age, red blood cells distribution width, neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), fibrinogen, sST2 level, CHA2DS2-VASc score and left atrial diameter in cerebral infarction group were higher than those in non-cerebral infarction group, and the differences were statistically significant（all P<0.05）. Cox multivariate regression analysis showed that age, NLR, MPV, fibrinogen, sST2 and CHA2DS2-VASc score were independent risk factors of acute cerebral infarction in NVAF patients(all P<0.05). Pearson correlation analysis showed that sST2 level was positively correlated with CHA2DS2-VASc score (r=0.653, P<0.001). The area under the receiver operating characteristic curve of sST2 combined with CHA2DS2-VASc score was higher than the two indexes alone to predict acute cerebral infarction in NVAF patients［0.926（95% confidence interval: 0.886-0.967） vs 0.886（95% confidence interval: 0.830-0.942）, 0.887（95% confidence interval: 0.843-0.931）］（Z=0.036, 0.037; both P<0.001）. The cut-off value of sST2 and CHA2DS2-VASc score to predict acute cerebral infarction in NVAF patients were 159.7 μg/L and 2 respectively. According to the cutoff value, 236 cases were divided into low-risk group (65 cases), medium-risk group (52 cases) and high-risk group (119 cases). Kaplan-Meier survival curve showed that the risk of acute cerebral infarction in NVAF patients in high-risk group was higher than that in low-risk group and medium-risk group （Log-rank χ2=33.701, 7.620; both P<0.001）. Conclusions  ST2 and CHA2DS2-VASc score are independent risk factors for acute cerebral infarction in patients with NVAF, and the combination of the two indicators can improve the predictive value of acute cerebral infarction in patients with NVAF.