缺血性脑卒中CISS分型与TOAST分型的比较及实用价值

目的初步比较CISS分型与TOAST分型，探讨CISS分型在急性缺血性脑卒中患者中的实用价值。方法收集2013年入住我院神经内科的150例急性缺血性脑卒中患者，分别由两位经分型培训的神经科医生根据患者的临床症状、影像学特点及相关辅助检查盲法行TOAST分型及CISS分型。比较两种分型法各亚型的构成比及差异。结果①TOAST分型中各亚型分布为：小动脉闭塞型54例（36．00％），大动脉粥样硬化性型39例（26．00％），不明病因型35例（23．33％），心源性栓塞型19例（12．67％），其他明确病因型3例（2．00％）。CISS分型中各亚型分布为：大动脉粥样硬化型78例（52．00％），穿支动脉疾病33例（22．00％），心源性脑卒中19例（12．67％），不明病因17例（11．33％），其他病因3例（2．00％）。②150例患者分别按TOAST分型和CISS分型方法分别进行分型，其中50例（33．33％）患者的分型发生变化。⑧2位经过培训的神经科医生使用TOAST分型时130例（86．67％）相同，Kappa值为0．82：采用C1SS分型时132例（88．00％）相同，Kappa值为0．81。结论急性缺血性脑卒中的CISS分型能更全面、准确地反映其病因及大动脉粥样硬化型的发病机制，减少原因不明的缺血性脑卒中的比例，为其诊治提供更为准确的依据。

Application significance of CISS classification on ischemic stroke and its comparison with TOAST classification

Objective To evaluate the CISS classification on ischemic stroke, and to find the difference and significance between CISS and TOAST classification. Methods Retrospective analysis to 150 cases suffered from acute ischemic stroke in neurology department of Shanghai Pudong hospital was performed. According to CISS and TOAST type, the patients above were classified by two doctors using blind method. The constituent ratio and subclassification differences in two methods were compared. Results ① The rank on etiology subtype of TOAST classification from high to low was： small-vessel occlusion （n=54, 36.00%）, large-artery atherosclerosis （n=39, 26.00%）, undetermined etiology （n=35, 23.33%）, cardioembolism （n=19, 12.67%）, stroke of other determined etiology （n=3, 2.00%）. The rank on etiology subtype of CISS classification from high to low was： large-artery atherosclerosis （n=78, 52.00%）, penetrating artery disease （n=33, 22.00%）, cardiogenic stroke （n= 19, 12.67%）, undetermined etiology （n=l 7, 11.33%）, other etiology （n=3, 2.00%）. ② While 150 cases of schemic stroke were respectively classified by TOAST and CISS classification, there was 50 cases subtype changed in two methods. ③When defining TOAST classification as diagnostic criteria, 130 cases were consistent with reality among patients （consistency 86.67%, Kappa value is 0.82）. When defining CISS classification as diagnostic criteria, 132 cases were consistent with reality among 150 patients （consistency 88.00%, Kappa value is 0.81）. Conclusion CISS classification on ischemic stroke can reflect the etiology and underlying mechanism of large-artery atherosclerosis. It may provide accurate basis for treatment and recurrence of ischemic stroke.