缺血性卒中病因分型法在中国卒中人群应用效果的比较  

Comparative Study of Two Etiological Classifications of Ischemic Stroke in Chinese Stroke Patients

作　　者：韩钊[1] 臧秋玲[1] 王苹莉[1] 肖美娟[1] 叶祖森[1] 

机构地区：[1]温州医学院附属第一医院脑血管科,浙江温州325000

出　　处：《心脑血管病防治》2010年第2期88-89,99,共3页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：温州市科技局Y2004A014

摘　　要：一医院脑血管科,温州325000目的:评价Adams等的TOAST分型法和SangWonHan等的新分型法的一致性,并研究用这两种分型法在中国卒中人群中诊断的各亚型的差异。方法:连续入选395例急性缺血性卒中患者,由一名神经科医生分别采用两种分型法在出院时进行病因分型,用χ2检验比较两种分型的各亚型比例的差异;同时,随机选取20例患者由两位神经科医生独立进行两种方法分型,采用Kappa分析评价研究者间的一致性。结果:(1)用TOAST分型法,两名医生对20例患者的病因分型有17例一致,K=0.78;采用SangWonHan新分型有18例一致,K=0.93。(2)TOAST分型的构成比:不明原因39.0%、小动脉闭塞29.6%、大动脉粥样硬化21.3%、心源性栓塞8.9%、其他明确病因1.3%;SangWonHan新分型的构成比:动脉粥样硬化血栓形成44.6%、不明原因25.1%、小动脉闭塞23.3%、心源性栓塞5.8%、其他明确病因型1.3%。结论:这两种分型法的研究者间的一致性都较高;与TOAST分型相比,SangWonHan新分型法,一致性更高,不明原因型的比例更少,动脉粥样硬化血栓形成型的比例增加。Objective To evaluate inter-investigator agreement between TOAST Classification proposed by Adams et al in 1993 and a new Classification proposed by Sang Won Han et al in 2007 and to study the difference of the proportion for each subtype in Chinese ischemic stroke patients diagnosed by the two Classifications respectively.Methods 395 Consecutive cases with acute ischemic stroke were enrolled in this study,their etiological subtypes were diagnosed at discharge by one neurologist according to the two Classifications and χ2 test was used to compare the difference of the proportion for each subtype.Meanwhile,two neurologists independently diagnosed subtype of 20 cases selected randomly and Kappa analysis was used to evaluate inter-investigators agreement.Results （1） Two investigators have agreement with the stroke subtype diagnosis in 17 out of 20 cases by TOAST criteria （k=0.78） and in 18 out of 20 cases by Sang Won Han et al new classification system（k=0.93）.（2） According to TOAST classification,the constituent ratio of subtypes for all enrolled cases was as following：stroke of undetermined etiology 39.0%,Small-artery disease 29.6%,Large-artery atherosclerosis 21.3%,cardioembolism 8.9%,Stroke of other determined cause 1.3%;By the new classification system of Sang Won Han,the constituent ratio subtypes was as following：atherothrombosis 44.6%,Stroke of undetermined etiology 25.1%,small-artery disease 23.3%,cardioembolism 5.8%,stroke of other determined cause 1.3%.Conclusions Both of the two classifications have excellent agreement.Compared with TOAST classification,the new classification proposed by Sang Won Han has higher agreement and less proportion of Stroke of undetermined etiology,and the proportion of atherothrombosis type increased.

关 键 词：缺血性卒中 TOAST分型 构成比 一致性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]