基于社区和区妇幼保健院的儿童脑发育障碍疾病的早期筛查及跟踪随访现状的研究

Study on the status of early screening and follow-up of neurodevelopmental disorder diseases in children in community-district level Maternal and Child Health Hospital

目的总结两家社区和区妇幼保健院针对发育迟滞(development delay,DD)、孤独症谱系障碍(autism spectrum disorder,ASD)及注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)3种疾病的早期筛查和跟踪随访情况,验证3种疾病的早期筛查流程,为形成此3种疾病的早期筛查流程提供有利的条件。方法选取2021年1—6月北京石景山苹果园社区卫生服务中心、鲁谷社区卫生服务中心和北京市石景山区妇幼保健院筛查的0~6岁儿童4029名,制定3种疾病的早期筛查流程,确立社区-区级妇幼保健院-医院联动模式,针对DD、ASD及ADHD进行早期筛查。结果两家社区使用"儿童心理行为发育问题预警征象"完成3577名0~3岁儿童的初筛,初筛阳性儿童52例(阳性率1.5%);石景山区妇幼保健院使用"Conners父母症状问卷"完成452名3~6岁儿童初筛,初筛阳性儿童8例(阳性率1.8%)。完成筛查的4029名儿童,初筛怀疑DD 26例(0.7%),最终确诊13例(50.0%);怀疑ASD 26例(0.7%),最终确诊9例(34.6%);怀疑ADHD 8例(1.8%),最终确诊5例(62.5%);不同性别的3种疾病初筛阳性率和确诊率比较,差异无统计学意义(P>0.05)。结论3种疾病的早期筛查流程有利于脑发育障碍儿童的早期发现,基于社区-区级妇幼保健院-医院联动模式开展3种疾病的早期筛查是可行的。

Objective To summarize the early screening and follow-up of three diseases[development delay(DD),autism spectrum disorder(ASD)and attention deficit hyperactivity disorder(ADHD)]in two communities and Shijingshan Maternal and Child Health(MCH)Hospital in Beijing,so as to verify the early screening process for the three diseases and provide favorable conditions for the formation of the early screening process.Methods An early screening process for the three diseases was developed,and a community-district level MCH hospital-hospital linkage model was established.The results of 4029 children undergoing early screening from January to June 2021 were analyzed.Results In the preliminary screening,"Warning Signs Checklist for Screening Psychological,Behavioral and Developmental Problems of Children"was used in 3577 children aged 0-3 years in the two communities,52 children(1.5%)had positive results."Conners Parent Symptom Questionnaire"was used in 452 children aged 3-6 years in Shijingshan MCH Hospital,eight children(1.8%)had positive results.A total of 4029 children completed the screening,26 children(0.7%)were suspected of DD,13 cases(50.0%)were finally diagnosed;26 children were suspected of ASD(0.7%),and nine cases(34.6%)were finally diagnosed;eight cases(1.8%)were suspected of ADHD,and five cases(62.5%)were finally diagnosed.There was no significant difference in the initial screening positive rate and the diagnosis rate of the three diseases of different genders(all P>0.05).Conclusions The early screening process for the three diseases is conducive to the early detection of children with brain developmental disorders.It is feasible to carry out the early screening of the three diseases based on the community-district level MCH hospital-hospital linkage model.