缺血性脑卒中NEW-TOAST病因学分型及与预后关系的研究

Classification and Prognosis of Ischemic Stroke Subtypes According to NEW-TOAST Criteria

目的:依据NEW-TOAST及TOAST分型对缺血性脑卒中进行构成比分析,了解NEW-TOAST各亚型与预后的关系。方法:选取2006年1月至2007年12月在暨南大学附属第一医院神经内科住院的缺血性脑卒中患者连续入组。收集所有病例的临床资料,采用NEW-TOAST、TOAST标准进行分型,随访患者1年后的复合终点事件,并做一致性检验。结果:共纳入296例患者,按照NEW-TOAST分型:动脉粥样硬化血栓型(AT)为39.86%;心源性脑栓塞型(CE)为6.42%;小动脉型(SAD)为26.35%;其他原因型(SOD)为1.35%;不明原因型(SUD)为26.01%。TOAST分型中有37例在新分型中转为其他亚型。新分型Kappa=0.81,显示为高度一致。1年随访期内,发生复合终点事件45例,其中AT型为20.56%;CE型为44.44%;SAD型为8.45%;SUD型为12.68%。经卡方检验,CE型的复合终点事件的发生率最高(P<0.05)。结论:缺血性脑卒中以NEW-TOAST分型中AT型所占比例最高,该分型的一致性好,可信度高,可以做为缺血性脑卒中研究的依据,值得进一步临床研究。

Aim： To analyze the subtypes of ischemic stroke patients according to acute stroke treatment（TOAST） criteria and the NEW-TOAST,and to analyze the prognosis of different subtypes according to the NEW-TOAST system.Methods： All patients with acute ischemic stroke were selected from the Department of Neurology,the First Hospital Affiliated to Jinan University from January 2006 to December 2007.All patients were classified in a double-blind way.Through one year of follow-up,we took over most of the compound end-points,which denoted the recurrence of cardiovascular and cerebral vascular diseases and vascular death.The neurologists independently used the NEW-TOAST classification system to evaluate the same 20 patients.Results： Total of 296 adults with acute ischmic stroke was selected orderly.According to NEW-TOAST,arterothrombosis（AT） counted for 39.86%;cerebral embolism（CE） counted for 6.42%;small artery disease（SAD） counted for 26.35%;some other disease （SOD） counted for 1.35%;some unidentified disease（SUD） counted for 26.01%.There were 37 cases classified to different subtypes in the NEW-TOAST.Interphysician agreement was very higher（Kappa =0.81）.There were 45 cases encountered the compound end-points.Among them,AT counted for 20.56%,CE counted for 44.44%,SAD counted for 8.45%,SUD counted for 12.68%.CE possessed the highest reoccurrence rate and there was statistically significance（P0.05）.Conclusion： Based on the NEW-TOAST,the most frequent subtype was AT.The NEW-TOAST system is easy to use and has good reliability.It can be investigated clinically.