中文摘要：

目的：比较CHADS2和CHA2DS2-VASc评分对非瓣膜性心房颤动（NVAF）患者卒中和血栓栓塞发生风险的预测价值。方法：系统性检索Cochrane图书馆,EMBASE、EBSCO和PubMed数据库中有关CHADS2和CHA2DS2-VASc评分预测NVAF患者卒中和血栓栓塞发生风险的英文文献。采用STATA 12.0软件进行统计分析。结果：本研究共纳入11篇文献。当C-统计量作为连续型变量分析时,CHADS2评分C-统计量分布从0.650到0.717,中位数0.660;CHA2DS2-VASc评分C-统计量分布从0.637到0.724,中位数0.697,合并后C-统计量分别为0.66（0.66~0.67）和0.67（0.66~0.68）。当C-统计量作为分类型变量分析时,CHADS2评分C-统计量分布从0.586到0.722,中位数0.630;CHA2DS2-VASc评分C-统计量分布从0.521到0.850,中位数0.606,合并后C-统计量分别为0.65（0.62~0.67）和0.63（0.59~0.68）,但存在高异质性,结果需慎重分析。CHA2DS2-VASc评分低危组的不良事件发生率明显比CHADS2评分低（0.54%：1.40%,P〈0.05）,且将更多的患者划分到高危组（81.0%：46.0%,P〈0.05）。结论：CHADS2和CHA2DS2-VASc评分对NVAF患者卒中和血栓栓塞发生风险的预测价值相类似。但CHA2DS2-VASc评分更容易发现真正＂低危＂患者,且将更多的患者纳入高危组,有利于指导临床上预防性治疗。

英文摘要：

Objective：To perform a meta-analysis of comparing the predictive abilities of stroke and thromboembolism between CHADS2 and CHA2DS2-VASc in nonvalvular atrial fibrillation（NVAF）patients.Method：The data were systematically retrieved by searching the Cochrane Library,PubMed and Embase databases to identify relevant cohort studies published in English,which reported the diagnostic performance of both CHADS2 and CHA2DS2-VASc scores.The STATA 12.0software was used to perform the statistical analysis.Result：Eleven studies were included.When analyzed as a continuous variable,the C-statistic ranged from 0.650 to 0.717（median 0.660）for CHADS2 and 0.637 to 0.724（median 0.697）for CHA2DS2-VASc.The pooled C-statistics were0.65（0.62-0.67）and 0.63（0.59-0.68）,respectively.When analyzed as a categorical variable,the C-statistic ranged from 0.586 to 0.722（median 0.630）for CHADS2 and 0.521 to 0.850（median 0.606）for CHA2DS2-VASc.The pooled C-statistics were（0.62-0.67）and 0.63（0.59-0.68）,respectively.Due to the high heterogeneity across studies,the results should be interpreted cautiously.The average ratio of adverse event in the low-risk group of CHA2DS2-VASc was less than that of CHADS2（0.54% vs 1.40%,P〈0.05）.The average proportion of the high-risk group of CHA2DS2-VASc was greater than that of CHADS2（81.0% vs 46.0%,P〈0.05）.Conclusion：The CHADS2 and CHA2DS2-VASc scores indicate similar clinical utility in predicting stroke and thromboembolism.However,the CHA2DS2-VASc score is much more advantageous in identifying extremely low-risk patients with NVAF.It also classifies a greater proportion of patients as high risk.This is beneficial in guiding the clinical preventive treatment.