Dietl M, Pohle R, Weingärtner M, Polgar R, Grässel E, Schwab S, Kolominsky-Rabas P
Interdisziplinäres Zentrum für Public Health der Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen.
Fortschr Neurol Psychiatr. 2009 Dec;77(12):714-9. doi: 10.1055/s-0028-1109912. Epub 2009 Nov 30.
About 80 % of all strokes are of ischemic origin. Among these the Trial of ORG 10 172 in Acute Stroke Treatment (TOAST) classification denotes five the etiological categories: large-artery atherosclerosis, cardioembolism, small-artery occlusion, strokes of undetermined etiology and strokes of other determined etiology, which are based on imaging and diagnostic findings. The object of research is the distribution of these TOAST categories in a demographically defined population and their impact on the need of care. The present study involves patients recruited within the population-based Erlangen Stroke Project (ESPro). The patients were analysed at time points after admission as well as 3 and 12 month after the event. results were presented as adjusted Odds Ratios (aOR). 1355 patients with a first-ever-in-a-lifetime ischemic stroke were registered in the Community of Erlangen. TOAST classification could be performed in 89 % (1206) of ischemic strokes. The etiological classification of brain infarctions resulted in 12 % large-artery atherosclerosis, 26 % cardioembolism, 24 % small-artery occlusion, 37 % strokes of undetermined etiology and 2 % strokes of other determined etiology. While 20 % of the patients were independent functionally at the Barthel index at admission, the number was 39 % after 12 month. The category large-artery atherosclerosis showed the strongest relationship with the occurring need of care. The aOR with very strong care needs 12.79 (95 % CI 3.71 -44.07) lay particularly high in comparison with an aOR of 6.95 (95 % CI 2.16 - 22.33) in the category cardioembolism. The TOAST classification provides an appropriate tool for estimating the need of care. In particular the patients in the TOAST category large-artery atherosclerosis showed a high level of a need of care at the long-term follow-up.
约80%的中风源于缺血性病因。在这些病例中，急性中风治疗中ORG 10172试验（TOAST）分类法指出了五种病因类别：大动脉粥样硬化、心源性栓塞、小动脉闭塞、病因不明的中风和其他明确病因的中风，这些分类基于影像学和诊断结果。研究对象是这些TOAST类别在特定人口统计学定义人群中的分布及其对护理需求的影响。本研究纳入了基于埃尔朗根人群的中风项目（ESPro）中招募的患者。在患者入院时以及事件发生后的3个月和12个月时进行分析。结果以调整后的比值比（aOR）呈现。在埃尔朗根社区登记了1355例首次发生的缺血性中风患者。89%（1206例）的缺血性中风可进行TOAST分类。脑梗死的病因分类结果为：12%为大动脉粥样硬化，26%为心源性栓塞，24%为小动脉闭塞，37%为病因不明的中风，2%为其他明确病因的中风。入院时，20%的患者Barthel指数显示功能独立，而12个月后这一比例为39%。大动脉粥样硬化类别与护理需求的相关性最强。与心源性栓塞类别中aOR为6.95（95%可信区间2.16 - 22.33）相比，有非常强烈护理需求的aOR为12.79（95%可信区间3.71 - 44.07），尤其高。TOAST分类法为评估护理需求提供了合适的工具。特别是TOAST分类为大动脉粥样硬化的患者在长期随访中显示出较高的护理需求水平。
