心房颤动患者预后评分系统的构建和比较

目的构建心房颤动人群预后预测工具,并对其预测能力进行比较评估。方法连续性纳入275例新发心房颤动患者,随访终点包括卒中和全因死亡。收集相关基线资料,检测患者基线血浆N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)、高敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)、生长分化因子15(growth differentiation factor-15,GDF-15)浓度。运用Cox比例风险模型构建卒中和死亡风险评分系统。应用C-统计量和校准图比较评分系统的预测能力。结果多因素Cox回归显示,糖尿病、短暂性脑缺血发作(transient ischemic attack,TIA)、卒中史、血浆NT-proBNP浓度与心房颤动患者卒中风险独立相关;年龄、心衰史、血浆hs-cTnT和GDF-15浓度与心房颤动患者全因死亡风险独立相关。我们构建的卒中风险评分系统预测能力与国外年龄、生物标志物和临床病史(age,biomarker,clinical history,ABC)卒中评分以及CHA2DS2-VASc评分相当,死亡风险评分系统与国外ABC死亡评分相当,优于CHA2DS2-VASc评分。结论本研究构建的心房颤动患者卒中和死亡风险预测评分系统表现出较好的预测性能,此评分系统的列线图可望作为临床决策的辅助工具。

Construction and comparative analysis of prognostic scoring system in patients with atrial fibrillation

  Objective   To construct a score system for predicting the prognosis of atrial fibrillation(AF) in China, and to compare its predictive ability.   Methods   A total of 275 patients with new-onset AF were continuously enrolled in the study. The outcome events of follow-up included stroke and all-cause mortality. Prognostic-related epidemiological and clinical information were collected. The blood concentration of N-terminal B-type natriuretic peptide(NT-proBNP), high-sensitivity troponin T(hs-cTnT) and growth differentiation factor(GDF)-15 were detected. A Cox proportional hazards regression model was used to develop novel risk scoring system. C-statistics and calibration plots were used to estimate and compare the predictive ability of risk scores.   Results   Multivariate Cox regression analysis showed that history of diabetes, history of transient ischemic attack, history of stroke and plasma level of NT-proBNP were independently associated with the risk of stroke. Age, history of heart failure, plasma level of hs-cTnT and GDF-15 were independent risk factors of all-cause mortality. The C-statistic of the stroke-risk score was similar to that of the CHA2 DS2-VASc score and ABC(age, biomarker, clinical history)-stroke score; the C-statistic of the death-risk score was similar to that of ABC-death score and significantly higher than that of the CHA2 DS2-VASc score.   Conclusions   The stroke and death risk scoring system of atrial fibrillation patients constructed in this study showed a good predictive performance. The nomograms of these scoring systems are expected to be auxiliary tools for clinical decision-making.