全身运动质量评估对高危儿神经发育结局的预测效度研究

Study on the predictive validity of quality evaluation of general movements for neurological development outcome of high risk infants

目的:比较GMs质量评估与传统的神经学检查方法对高危儿神经发育结局预测的价值。方法:将2008年9月～2009年8月在安徽医科大学第三附属医院出生的除外先天性缺陷以及家族遗传病的197例高危儿,应用全身运动质量评估、0～1岁52项神经运动检查在出生后的不同阶段进行评估,1岁时应用《贝利婴幼儿发展量表》中的运动量表评估高危儿是否有神经行为发育异常。结果:GMs质量评估结果显示,早产和扭动运动阶段:正常者146例,异常者51例,敏感度88.89%,特异度84.12%,阳性预测值47.06%,阴性预测值97.95%;不安运动阶段:正常169例,异常为28例,敏感度81.48%,特异度96.47%,阳性预测值78.57%,阴性预测值97.04%。0～1岁52项神经运动检查结果显示,正常者94例,异常为103例,敏感度92.59%,特异度54.12%,阳性预测值24.27%,阴性预测值97.87%。三者的Kappa值分别为0.531、0.768和0.214。结论:全身运动质量评估与传统的神经学检查方法相比在预测高危儿的神经发育学结局方面具有较高的敏感度、特异度、阳性预测值及一致性,适合在我国应用和推广。

Objective：To compare the values of quality evaluation of general movements and traditional neurological examination method for prediction of neurological development outcome of high risk infants.Methods：197 high risk infants（except the infants with congenital defects and hereditary diseases） who were born in the hospital from September 2008 to August 2009 were evaluated by quality evaluation of general movements and neuro-motorial examination（52 items for the infants aged 0~1 year） during different periods after birth.Movement scale of Bayley Scales of Infant Development（BSID） was used to evaluate the high risk infants combined with neurobehavioral abnormalities or not when the infants were one year.Results：The results of quality evaluation of general movements showed that during premature birth and writhing movements periods,146 normal infants and 51 abnormal infants were found,the sensitivity,specificity,positive predictive value and negative predictive value were 88.89%,84.12%,47.06% and 97.95%,respectively;during fidgety movements period,169 normal infants and 28 abnormal infants were found,the sensitivity,specificity,positive predictive value and negative predictive value were 81.48%,96.47%,78.57% and 97.04%,respectively.The results of neuro-motorial examination（52 items for the infants aged 0~1 year） showed that 94 normal infants and 103 abnormal infants were found,the sensitivity,specificity,positive predictive value and negative predictive value were 92.59%,54.12%,24.27% and 97.87%,respectively.The Kappa values of them were 0.531,0.768 and 0.214,respectively.Conclusion：Compared with traditional neurological examination method,quality evaluation of general movements have higher sensitivity,specificity,positive predictive value and negative predictive value in the aspect of predicting neurological development outcome of high risk infants,and it is suitable for application and spread in China.