摘要
目的探讨适合基层的孤独症谱系障碍(autism spectrum disorder,ASD)早期筛查方法,提高基层医生对ASD的识别能力。方法采用回顾性研究方法,选取2020年10月至2021年7月于成都市金牛区妇幼保健院进行定期健康体检的18~30月龄儿童为研究对象,使用婴幼儿孤独症筛查-23(checklist for autism in toddlers-23,Chat-23)量表结合ASD预警征询问和现场观察的初级筛查方法,共筛查2437名。对筛查阳性并确诊发育异常的31名儿童使用象征性游戏测试(symbolic play test,SPT)和婴幼儿语言发育筛查量表进行评估,探讨适合基层医院开展的ASD早期筛查方式。统计学方法采用单因素方差分析、χ^(2)检验、Fisher确切概率法、受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果男童和女童Chat-23量表A部分阳性率[2.11%(27/1281)与0.95%(11/1156),χ^(2)=5.292,P=0.021]、B部分阳性率[2.03%(26/1281)与0.61%(7/1156),χ^(2)=9.226,P=0.002]比较,男童明显高于女童,而不同月龄儿童Chat-23量表A部分、B部分阳性率比较差异均无统计学意义(P值均>0.05);不同性别、儿童ASD预警征、现场观察阳性率比较,差异均无统计学意义(P值均>0.05)。ROC曲线分析结果显示,Chat-23量表筛查ASD的曲线下面积(area under the curve,AUC)为0.946,敏感度为90.00%,特异度为99.18%(P<0.05)。ASD患儿SPT量表、婴幼儿语言发育筛查量表B部分得分均明显低于全面发育迟缓和语言发育迟缓患儿,差异均有统计学意义(P值均<0.05);3组患儿在婴幼儿语言发育筛查量表A部分和C部分得分方面,差异均无统计学意义(P值均>0.05)。结论Chat-23量表可用于基层医院早期筛查ASD,结合SPT量表和婴幼儿语言发育筛查量表可以提高基层医生对ASD的鉴别诊断能力。
Objective To explore the early screening method of autism spectrum disorder(ASD)suitable for primary hospitals,and improve the ability of primary doctors to identify ASD.Method A total of 2437 children aged 18-30 months who received regular child health care in the Jinniu Maternity and Child Health Hospital of Chengdu from October 2020 to July 2021 were retrospectively selected as the research objects.In order to screen ASD,the primary screening methods of the checklist for autism in toddlers-23(Chat-23)scale,the ASD early warning inquiry and field observation were applied.A total of 31 children with positive results and confirmed dysplasia were evaluated using the symbolic play test(SPT)and the infant language development screening scale to explore the early ASD screening methods for primary care hospital.Statistical methods performed by One-way analysis of variance,χ^(2) test,Fisher exact probability method and receiver operating characteristic(ROC)curve analysis.Result In the boys,the positive rates of part A of Chat-23 scale[2.11%(27/1281)vs 0.95%(11/1156),χ^(2)=5.292,P=0.021]and the positive rates of part B of Chat-23[2.03%(26/1281)vs 0.61%(7/1156),χ^(2)=9.226,P=0.002]were significantly higher than those of girls.There was no significant difference in the positive rates of part A and part B of Chat-23 scale in children of different ages(all P>0.05).There was no statisticant significance in the positive rates of the ASD early warning and field observation among children of different genders and ages(all P>0.05).ROC curve analysis showed that the area under the curve(AUC)of Chat-23 scale for screening ASD was 0.946,the sensitivity was 90.00%,and the specificity was 99.18%(P<0.05).The scores of SPT scale and part B of infant language development screening scale in children with ASD were significantly lower than those in children with global development delay and language development delay,and the differences were statistically significant(all P<0.05).There were no significant differences in the scores of part A and part C of infant language development screening scale among the three groups of children(all P>0.05).Conclusion Chat-23 scale can be used for early screening of ASD in primary hospitals.The combination of SPT scale and infant language development screening scale can improve the differential diagnosis ability of doctors in primary hospitals for ASD.
作者
张颖
付云蓉
李玉仙
杨文旭
Zhang Ying;Fu Yunrong;Li Yuxian;Yang Wenxu(Department of Child Health Care,Jinniu Maternity and Child Health Hospital of Chengdu,Sichuan,Chengdu 610000,China;Department of Child Health Care,Chengdu Women's and Children's Central Hospital,Affiliated Women's and Children's Hospital,School of Medicine,University of Electronic Science and Technology of China,Sichuan,Chengdu 611731,China)
出处
《发育医学电子杂志》
2025年第1期19-25,共7页
Journal of Developmental Medicine (Electronic Version)
基金
四川省科技计划资助项目(2020YFS0484)。
关键词
孤独症
早期筛查
量表应用
效果分析
基层医院
Autism
Early screening
Scale application
Effect analysis
Primary hospital
作者简介
通信作者:杨文旭(Email:mei_mei_yang@163.com)。
