缺血性卒中TOAST、ASCO、CISS病因分型的比较研究

Ischemic Stroke Subtype Classification: A Comparative Study of TOAST,ASCO and CISS

目的探讨缺血性卒中TOAST、ASCO、CISS病因分型的异同。方法连续收集并筛选出2012年7月—2012年11月我院住院缺血性卒中患者249例,按照TOAST、ASCO、CISS分型标准分别进行病因分型,比较其对各病因学亚型诊断的差异性及一致性。结果 ASCO、CISS与TOAST相比较,病因不确定型比例均降低(P<0.0001,P=0.0007),大动脉粥样硬化型比例均升高(P<0.0001);ASCO分型中小血管性相对增加28.1%(P<0.0001),心源性相对增加50.0%(P=0.0047);CISS分型中穿支动脉疾病相对减少21.9%(P<0.0001)。CISS与ASCO比较,穿支动脉疾病(或小血管性)、心源性及病因不确定型差异均有统计学意义(P<0.05),大动脉粥样硬化型及其他病因型差异均无统计学意义(P>0.05)。一致性检验表明:3种病因分型中,多数亚型间的诊断存在较好一致性,少数亚型间的诊断一致性中等或尚可。结论 3种病因分型方法对各亚型的诊断均存在一致性。ASCO、CISS分型诊断标准较TOAST更为科学、合理、准确。ASCO较CISS病因诊断更全面,CISS较ASCO病因机制研究更深入。

Objective To compare the differences in ischemic stroke subtype classification criteria including TOAST, ASCO and CISS. Methods A total of 249 patients with acute ischemic stroke treated in our hospital from July 2012 to November 2012 were included in our study. They were classified according to TOAST, ASCO and CISS. The differences were compared a- mong the three approaches. Results ASCO and CISS assigned fewer patients as cause undetermined （ P 〈 0. 0001, P = 0. 0007 ）, with increased assignment of large artery atherosclerosis （ P 〈 0. 0001 ） compared with TOAST. The proportions of small - vessel occlusion and cardioembolism increased using ASCO compared with using TOAST （ the relative increase rate ： 28.1% , P 〈 0. 0001 ; 50. 0%, P = 0. 0047 ）. The proportion of penetrating artery disease decreased by 21.9% using CISS, compared to using TOAST （ P 〈 0. 0001 ）. Comparison between CISS and ASCO showed that there was significant difference in the proportions of penetrating artery disease （ small - vessel disease）, cardioembilism and stroke of undetermined etiology （ P 〈 0. 05 ） , but no significant difference in large artery atherosclerosis and other etiology （ P 〉 0. 05 ）. The consistency level between the three classification systems ranged from fair to excellent. Condusion Consistency can be found among the three approaches. However, ASCO and CISS are more scientific, reasonable and accurate than TOAST. ASCO is with more comprehensive etiolog- ical information of stroke, while CISS provides more information on the pathogenesis of stroke.