缺血性卒中病因分型：CISS、SPARKLE、TOAST一致性分析

发布时间：2018-10-05 15:50

【摘要】：背景及目的:目前存在数种缺血性卒中病因分型系统,合适的分型系统应当具备高的信度及效度特点,以便于在不同研究中心应用。急性卒中抗凝治疗试验(Trial of Org 10172 in Acute Stroke Treatment,TOAST)分型是经典的病因分型系统。中国缺血性卒中亚型分型(Chinese Ischemic Stroke Subclassification,CISS)、缺血性卒中分型系统亚型(Subtypes of Ischemic Stroke Classification System,SPARKLE)是较新出现的病因分型系统,三者之间还没有进行过一致性分析。本文目的旨在探讨CISS、SPARKLE、TOAST三者之间一致性情况及CISS病因分型系统的内在一致性分析。方法:数据来自2015.10.01至2016.4.19首都医科大学附属北京天坛医院神经病学中心血管神经病学科收住院623例急性缺血性脑卒中患者;根据本研究的入组标准及排除标准,407例为符合要求的首次脑梗死发病患者,然后结合相关研究样本量情况,连续抽取299例患者作为本研究的入组样本量,并进行病因分型及一致性分析。结果:CISS、SPARKLE、TOAST三者之间具有肯定一致性:CISS与SPARKLE(kappa值=0.684,P㩳0.001)、CISS与TOAST(kappa值=0.615,P㩳0.001)、SPARKLE与TOAST(kappa值=0.675,P㩳0.001)。CISS病因分型内在一致性较好(kappa值=0.857,P㩳0.001)。另外各病因亚型之间差异性分析结果为:对于大动脉粥样硬化(Large-artery Atherosclerosis)、不明原因(Undetermined Etiology)病因亚型,三者之间均有显著差异性,P㩳0.05;对于心源性栓塞(Cardioembolism)、其它病因(Other Etiology)中,三者之间均无显著性差异,P㧐0.05;在小血管病病因(Small Vessel Disease)中,CISS与SPARKLE、CISS与TOAST之间存在显著性差异,P㩳0.05,但SPARKLE与TOAST之间无显著性差异,P=0.824。结论:CISS、SPARKLE、TOAST三者病因分型系统之间具有肯定一致性;CISS病因分型内在一致性较好,适合不同研究中心之间应用及进行数据对比研究。
[Abstract]:Background and objective: there are several etiological classification systems for ischemic stroke. The suitable classification system should have the characteristics of high reliability and validity in order to be used in different research centers. Acute stroke anticoagulant therapy trial (Trial of Org 10172 in Acute Stroke Treatment,TOAST) is a classic etiological classification system. Chinese ischemic stroke subtype (Chinese Ischemic Stroke Subclassification,CISS) and ischemic stroke subtype (Subtypes of Ischemic Stroke Classification System,SPARKLE) are relatively new etiological classification systems. There has not been a consistent analysis among them. The purpose of this study was to explore the consistency among the three CISS,SPARKLE,TOAST and the analysis of the internal consistency of the etiological classification system of CISS. Methods: the data were collected from 623 patients with acute ischemic stroke in neurology department of Temple of Heaven Hospital affiliated to Beijing Capital Medical University from January 1 to April 19, 2015.The data were collected from 623 patients with acute ischemic stroke. According to the criteria of admission and exclusion, 407 patients with first cerebral infarction were selected as the sample size of this study, and 299 consecutive patients were selected as the sample size of this study. The etiological classification and consistency were analyzed. The results showed that there was a definite consistency between the two parts: the SPARKLE (kappa value was 0.684? 0.001) CISS and TOAST (kappa value 0. 615? 0.001) SPARKLE and TOAST (kappa value 0. 675? The internal consistency of the etiological classification of CISS was good (kappa value: 0.857P? 0.001) The results showed that there were significant differences in the etiological subtypes of Large-artery Atherosclerosis), (Undetermined Etiology) with unknown cause). There was no significant difference among the three groups in other etiological (Other Etiology) of cardiac embolism (Cardioembolism),). In the etiology of small vascular disease (Small Vessel Disease), there was significant difference between CISS and SPARKLE,CISS and TOAST. But there was no significant difference between SPARKLE and TOAST. Conclusion there is a definite consistency among the etiological classification system of SPARKLETOAST, which is suitable for the application of different research centers and the comparative study of data.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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