急性脑梗死症状学、影像学及病因学分类之间的关系研究

目的：探讨急性脑梗死症状学、影像学及病因学分类之间的关系。方法：对125例起病48小时内的急性脑梗死患者进行3步骤分类诊断，第一步为症状学分类：(1)完全前循环梗死(TACI)；(2)部分前循环梗死(PACI)；(3)腔隙性梗死(LACI)；(4)后循环梗死(POCI)。第二步为影像学分类：(1)前循环皮质梗死或纹状体内囊区梗死(C0)；(2)低灌流梗死(LFI)；(3)深穿技区的皮质下小梗死(SSI)；(4)除SSI以外的后循环梗死(PCI)；(5)无异常发现(N0)。第三步为病因学分类：(1)大动脉粥样硬化(LAA)；(2)心源性栓塞(CE)；(3)小动脉病(SAD)；(4)其它病因、病因不明或混合性病因。结果：在症状学分类诊断为TACI、PACI和POCI的患者中，CT或MRI所示病灶与其临床症状的对应性良好，但只有67．3％的LACI影像学分类为SSI。大多数TACI患者是由CE造成的。在PACI患者中，CE和LAA的数量相同。只有57．7％的LACI患者被划分为SAD，而28．8％被划分为LAA。用LACI和SSI来预测SAD的阳性预测率较高(78％)。POCI的病因诊断多种多样。结论：除LACI以外，症状学分类与影像学分类的对应性良好，用症状学分类可预测TACI和PACI患者的病因分类，但难以预测POCI患者的病因分类。不少的LACI是由LAA造成的。

Correlation between symptomatic, radiological and etiological classification in acute ischemic stroke

Objective To study the correlation between symptomatic, radiological and etiological classification in acute ischemic stroke. Methods One hundred and twenty five patients with ischemic stroke within 48 hour of onset were prospectively studied with three step diagnosis: (1) symptomatic classification based on the Oxfordshire Community Stroke Project criteria (OCSP), (2) radiological classification(CT or MRI) and (3) etiological classification based on the Lausanne Stroke Registry criteria.Results Most of the patients with symptoms of total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI) and posterior circulation infarcts (POCI) according to OCSP classification had corresponding lesions on CT or MRI, while only 67.3% of lacunar infarcts (LACI) patients had small subcortical infarction (SSI). More than 60% of patients with TACI were classified into cardioembolism (CE) in the third diagnosis, while the etiology of PACI was either CE or large artery atherosclerosis (LAA) in equal numbers. Only 57.7% of LACI patients were classified into small artery disease (SAD) and 28.8% of them into LAA, of which 80% patients had lesions other than SSI. The positive predictive value of SAD in the combination of LACI and SSI was 0.78. The etiology of POCI was variable.Conclusion Except for LACI, the symptomatic classification by OCSP corresponds well to the radiological classification. The etiological classification can be predicted in TACI and PACI, but it is hard to make in POCI, a number of LACI are due to LAA.