全身运动质量评估结合Vojta 7项姿势反射对高危儿脑性瘫痪的预测研究

Agreement between general movements assessment and Vojta posture reflex examination in high risk infants

目的研究全身运动(GMs)质量评估和Vojta姿势反射检查评估高危儿脑性瘫痪(CP)的一致性。方法以2012年2月至2014年11月于该院康复科就诊并随访至1岁的310例高危新生儿为研究对象,收集基本信息,GMs评估、Vojta姿势检查及粗大运动发育量表结果,随访至患儿1岁,使用SPSS13.0进行统计学分析。结果 (1)GMs评估中110例表现为不安运动缺乏(F-),8例表现为痉挛-同步性(CS)全身运动。GMs评估对高危儿CP预测的效度:灵敏度87.27%,特异度89.00%,阳性预测值81.35%,阳性似然比2.40,阴性似然比0.04。(2)Vojta姿势反射检查阴性131例,阳性179例,其中轻度异常者132例,中度异常者77例,重度异常者32例。Vojta姿势反射检查对高危儿CP预测的效度:灵敏度98.18%,特异度33.50%,阳性预测值44.81%,阳性似然比2.93,阴性似然比0.447。(3)两种检查方法预测CP的阳性率比较,差异有统计学意义(P<0.001),一致性不理想(κ=0.22,P<0.01)。结论 GMs评估及Vojta姿势反射检查一致性不理想,GMs评估优于Vojta姿势反射检查。

Objective To investigate the consistency between general movements assessment（GMs）and Vojta posture reflex examination in assessing high risk infants for cerebral palsy.Methods Retrospective review was performed on 310 high risk infants who were diagnosed in Department of Rehabilitation in Children′s Hospital of Chongqing Medical University from february 2012 to November 2014.The basic information,GMs assessment,Vojta posture reflex examination and gross motor development scale results were collected,and these infants were followed-up to the age 1year old.The SPSS13.0software was applied for statistical analysis.Results（1）Totally 110 infants showed fidgety movements and 8cases showed cramped-synchronised movements in GMs assessment.The predictive values of GMs assessment for cerebral palsy were as follows：sensitivity 87.27%,specificity 89.00%,positive predictive value 81.35%,positive likelihood ratio 2.40,negative likelihood ratio 0.04.（2）There were 131 cases with negative reswlts of Vojta posture reflex examination and 179 cases with positive results,in which 132 cases were mild abnormal,33 cases were moderate abnormal,14 cases were severe abnormal.Predictive values of Vojta postural reflex test for high risk infants with cerebral palsy were as follows：sensitivity 98.18%,specificity 33.50%,positive predictive value 44.81%,positive likelihood ratio2.93,negative likelihood ratio 0.45.（3）The difference of the positive rate of two methods in predicting cerebral palsy was statistically significant（P〈0.001）,and the consistency was not ideal（κ=0.22,P〈0.01）.Conclusion The consistency between GMs assessment and Vojta posture reflex examination is not ideal,and GMs assessment is superior to Vojta posture reflex examination.