整合视听连续测试诊断注意缺陷多动障碍的临床应用探讨

Value of integrated visual and auditory continuous performance test in the diagnosis of childhood attention deficit hyperactivity disorder

目的以往我国医学界对注意缺陷多动障碍（ADHD）诊断缺乏客观的量化诊断指标，近年来有研究显示，整合视听连续测试（IVA—CPT）对ADHD具有辅助诊断价值。该文旨在研究IVA-CPT对ADHD诊断的临床应用价值。方法分别以中国精神疾病分类方案与诊断标准第3版（CCMD-3）或美国精神障碍诊断和统计手册第4版（DSM—IV）为对照，对166例临床怀疑ADHD患儿进行IVA-CPT诊断，并分为6—9岁及10～15岁两组，统计分析结果，对比、评价其临床意义。结果以CCMD·3为参照标准，IVA-CPT诊断ADHD的敏感度为72．7％，特异度为46．0％，经疋。相差分析，两种方法阳性检出率差异无显著性（P〉0．05）；以DSM—IV为参照标准，IVA—CPT敏感度为71．6％，特异度为56．5％，经X^2分析两种方法阳性检出率差异无显著性（P〉0．05），对ADHD临床分型诊断两种方法同样差异无显著性（P〉0．05）；以两种参照标准对照，IVA—CPT对ADHD的诊断，10～15岁组敏感度与特异度均低于6—9岁组。结论IVA—CPT可以作为对ADHD诊断的辅助检查方法，对低年龄组ADHD患儿诊断效果更佳，较大年龄ADHD患儿诊断除做IVA—CPT外，还要结合DSM—IV量表或CCMD-3量表等综合诊断。

Objective To study the value of the integrated visual and auditory continuous performance test （IVA- CPT） in the diagnosis of childhood attention deficit hyperactivity disorder （ADHD）. Methods IVA-CPT was performed in 153 children （6-15 years old） with suspected ADHD. The ＂gold standard＂ for the diagnosis of ADHD was based on the Chinese Classification and Diagnostic Criteria of Mental Disease （3rd version） （CCMD-3） or the Diagnostic and Statistical Manual of Mental Disorders （4th version, USA） （DSM-IV）. Results When CCMD-3 was used as the ＂gold standard＂, the sensitivity and specificity of IVA-CPT for the diagnosis of ADHD were 72.7% and 46.0% respectively. There were no significant differences in the diagnostic positive detection rate between the two diagnostic ways. When DSM-IV was used as the ＂gold standard＂, the sensitivity and specificity of IVA-CPT for the diagnosis of ADHD were 71.6% and 56.5% respectively. There were no significant differences in the diagnostic positive detection rate between the two diagnostic ways. There were similar results in the identification of subtypes of ADHD by the two diagnostic ways. The sensitivity and specificity of IVA-CPT for the diagnosis of ADHD in the 10-15 years old group were lower than those in the 6-9 years old group when either CCMD-3 or DSM-IV was used as the ＂gold standard＂. Conclusions IVA-CPT can be used as an assisted tool for the diagnosis of ADHD. It is more effective for the diagnosis of ADHD in younger children.