摘要
目的探讨TOAST、ASCO和CISS分型在缺血性卒中病因学分型临床应用中的差异。方法连续收集167例首次发病的缺血性卒中患者，分别进行TOAST、ASCO以及CISS分型，比较其对各病因学亚型诊断的差异性和一致性。结果与TOAST比较，ASCO-1会显著性增高大动脉粥样硬化组（23．4％对19．8％；，=4．167，P=0．031）和降低小血管疾病组（32．9％对38．3％；x2=4．923，P=0．022）的患者比例；同样，CISS也会显著性增高大动脉粥样硬化组（37．1％对19．8％；X2=27．034，P〈0．001）和降低小血管疾病组（19．2％对38．3％；Xz=25．289，P〈0．001）的患者比例。不过，ASCO-1（34．1％对28．1％；x2=3．682，P=0．052）和CISS（32．9％对28．1％；r=0．880，P=0．268）均不会降低病因不明组的患者比例。3种分型方法的一致性介于中等（TOAST／ASCO-1的其他病因组，K=0．434）和极好（TOAST／ASCO-1的心源性栓塞组，K=0．967）之间。结论ASCO-1和CISS分型均不能降低病因不明性卒中亚型患者的比例，但各亚型之间一致性较好。在临床应用中，应关注3种分型方法中各亚型诊断标准的设计和特点。
Objective To investigate the differences in the clinical application of the etiological subtypes of ischemic stroke according to the TOAST, ASCO and CISS criteria. Methods A total of 167 consecutive patients with fist-ever ischernic stroke were enrolled in the study. They were classified with the TOAST, ASCO and CISS criteria, respectively. The differences and consistency of subtype diaglosis of each etiology were compared. Results Compared with TOAST, ASCO grade 1 significantly increased the proportion of patients in a large atherosclerosis group （23.4% vs. 19. 8% ;X2 = 4. 167, P = 0. 031） and decreased that in a small vessel disease group （32. 9% vs. 38. 3% ; X2 = 4. 923, P = 0. 022）; similarly, CISS also significantly increased the proportion of patients in the large atherosclerosis group （37. 1% vs. 19. 8% ;X2 = 27. 034, P 〈 0. 001） and decreased that in the small vessel disease group （19. 2% vs. 38. 3% ; X2 = 25. 289, P 〈 0. 001 ）. However, ASCO grade 1 （34. 1% vs. 28. 1% ; X2 = 3. 682, P = 0. 052） and CISS （32. 9% vs. 28. 1% ; X2 = 0. 880, P =0. 268） did not decrease the proportion of patients in a cryptogenic group. The consistency of the 3 typing methods was between moderate （other etiology group of TOAST/ASCO-1, K = 0. 434） and excellent （cardioembolism group of TOAST/ASCO-1, K =0. 967）. Conclusions Both ASCO-1 or CISS typing may not decrease the proportion of the patients with the subtype of cryptogenic stroke, but the consistency among all the subtypes was better. The design and characteristics of the diagnostic criteria in all subtypes with the 3 criteria should be considered in clinical practice.
出处
《国际脑血管病杂志》
北大核心
2013年第6期430-434,共5页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
危险因素
结果可重复性
Stroke
Brain Ischemia
Risk Factors
Reproducibility of Results
