缺血性卒中病因分型发展

Development of Ischemic Stroke Etiological Classification

准确的缺血性卒中病因分型与病理生理、临床特征、疗效评估和预后相关。卒中目前存在数种病因分型系统,根据分类方式可分为表型分类系统及成因分类系统。前者主要根据检查结果可将一位卒中患者归为多个并列的病因,如动脉粥样硬化、小血管病、心源性和其他原因(atherothrombosis,small vessel disease,cardiac causes,and other uncommon causes,ASCO)分型;后者则把检查结果与临床表现相结合,经过分析做出一个最可能的病因,如急性卒中治疗低分子肝素试验(Trial of Org 10 172 in Acute Stroke Treatment,TOAST)分型、病因分类系统(causative classification system,CCS)。每种分型都有自身的优点及局限性。理想的分型系统应当有效、一致性高、易操作、基于证据及能够结合最新的研究成果。

One precise ischemic stroke etiological classification should embody the physiopathologic mechanism, clinical features, therapeutic regimen and prognosis. From the Harvard Stroke Registry to the present, there have been several causative classification systems with the development of diagnosis technology and the deepening of understanding the disease, which include two major systems： phenotypic classification system and causative classification system. The character of phenotypic classification system is that one patient may be cataloged several collateral etiologies according to the examination findings, such as atherothrombosis, small vessel disease, cardiac causes, and other uncommon causes （ASCO）; while the causative classification system is that it combines the clinical features and auxiliary examinations to obtain a single most-likely etiology through decision-making process, such as Trial of Org 10172 in Acute Stroke Treatment （TOAST） classification and causative classification system （CCS）. However, every classification system has its advantage and limitation. One ideal stroke classification system should be one that is valid, high reliability, easily operating, evidence-based, and integrated with new research results.