缺血性脑卒中病因学分类系统的研究

Study on etiologic classification of ischemic stroke

目的探讨缺血性脑卒中病因学分类系统——急性卒中Orgl 10172治疗试验(TOAST)、停止卒中研究TOAST系统(SSS-TOAST)和ASCO三者的差异。方法对300例新发缺血性脑卒中患者分别采用TOAST、SSS-TOAST和ASCO系统进行病因学诊断,比较各个分类系统中同一亚型的比例,以及不同评价者之间的可信度。结果与TOAST比较,SSS-TOAST中心源性栓塞(CE)、大动脉粥样硬化(LAA)、小血管闭塞(SVO)及其他原因(ODA)卒中的比例明显增高,而原因不明(UDA)卒中的比例明显降低(均P<0.01)。与SSS-TOAST比较,ASCO1中CE、SVO及ODA的比例明显降低,而UDA或非ASCO1的比例明显增高(均P<0.01)。TOAST的可信度为0.732,SSS-TOAST的可信度为0.915,ASCO的可信度为0.863。与TOAST比较,ASCO1+2中SVO的比例明显增高,而UDA或非ASCO1+2的比例明显降低(均P<0.01)。结论与TOAST相比,SSS-TOAST在不降低可信度的情况下,可以有效减少UDA的比例;而ASCO虽然不能够减少UDA的比例,但最大限度的保存了患者的临床信息。

Objective To investigate the differences among the three etiologic classifications of ischemic stroke- trial of Orgl10172 in acute stroke treatment （TOAST）, stop stroke study-TOAST （SSS-TOAST） and ASCO. Methods The 300 first-ever ischemic stroke patients were classified by TOAST, SSS-TOAST and ASCO, respectively. The proportion of the same subtype was compared among different classifications, and the reliability of which was valued. Results Compared with TOAST, the proportions of cardiogenic embolism （CE）, large artery atherosclerosis （LAA）, small vessel occlusion （SVO） and other aetiology （ODA） in SSS-TOAST were significantly increased, while the proportion of unknown aetiology （UDA） was significantly decreased （ all P 〈 0. 01 ）. Compared with SSS-TOAST, the proportions of CE, SVO and ODA in ASCO1 were significantly decreased, while the proportions of UDA and non-ASCO1 were significantly increased （ all P 〈 0.01 ）. The reliability of TOAST was 0.732, which of SSS-TOAST was 0.915, and which of ASCO was 0. 863. Compared with TOAST, the proportions of SVO in ASCO1 ＋ 2 were significantly increased, while the proportions of UDA and non-ASCO1 ＋ 2 were significantly decreased （all P 〈 0. 01 ）. Conclusion Compared with TOAST, SSS-TOAST can reduse the proportion of UDA without decrease the reliability. ASCO can not decrease the proportion of UDA, but can preserve the most clinical information of patients.