孤独症患儿早期发育筛查方法比对与临床意义研究

Study on the comparison of early developmental screening tools and related clinical significance among children with autism

目的探索儿童早期孤独症筛查方法在儿童保健工作中的应用价值,为选择适宜的筛查方法提供参考依据。方法选取2013-2018年间在闵行区妇幼保健院接受儿童保健系统管理的儿童共计2639名,于24月龄接受婴幼儿孤独症筛查量表(CHAT-23)筛查的儿童2525名,其中1979名儿童于24月龄同时接受了0~6岁发育筛查测试(DST),通过电子健康档案系统收集这部分儿童24月龄CHAT-23结果、智测结果,是否发生儿童孤独症及发育结局。比较CHAT-23结合智测筛查方法与单独使用CHAT-23量表筛查儿童孤独症的预测作用。结果接受2周岁系统保健的2639名儿童中最终确诊儿童孤独症34名,CHAT-23对于儿童孤独症筛查的灵敏度为0.265,将DST筛查结果的DQ、MI结果的可疑/异常作为联合筛查方法,可提高儿童孤独症筛查灵敏度(0.906 vs.0.265),对于避免漏诊具有重要意义,筛查效果也较单一方法好(约登指数0.481vs.0.261)。结论CHAT-23量表结合智测筛查方法在发现孤独症患儿的筛查效果比单纯使用CHAT-23量表高,医生客观观察结果与家长主观填写相结合可对早期儿童孤独症准确诊断,便于早期发现、诊断、治疗以改善患儿预后,值得基层儿童保健临床工作应用。

Objective To evaluate the application of screening tools for autism spectrum disorder(ASD)in children in the primary child healthcare service,so as to provide advisable information for selecting appropriate tools.Methods A total of 2639children received physical examination in Minhang Maternal and Child Health Care Center from 2013to 2018 were selected in this study,of whom 2525were conducted CHAT-23screening test and 1979received Developmental Screening Test for Child under six(DST).Both screening tests above and autism diagnosed results were collected from Minhang electronic health record retrospectively,so as to compare the predictive value of single screening test alone with joint screening test.Results Finally 34children were diagnosed with ASD among 2639children.And the sensitivity CHAT-23for screening ASD was 0.265.Compared with CHAT-23screening ASD alone,CHAT-23combined with DST suspicious results of DST together could higher the sensitivity(0.906vs.0.265)and Youden index(0.481vs.0.261),which is of great significance for avoid missed diagnosis.Conclusion Considering the high accuracy of both CHAT-23 results filled out by parents and DST results conducted by physicians,this method will improve the of screening child autism and help early detection,diagnosis and intervention of child autism,and is worthy being used in primary child health care service.