脑干听觉诱发电位联合CARS、ABC对儿童孤独症的诊断意义

Diagnostic value of brainstem auditory evoked potentials combined with CARS and ABC for ASD in children

目的探讨脑干听觉诱发电位(BAEP)、儿童孤独症评定量表(CARS)及孤独症行为量表(ABC)在儿童孤独症谱系障碍(ASD)诊断中的应用价值。方法选取2020年1月至2022年6月在湖北省妇幼保健院儿童保健科就诊的疑似ASD患儿77例,根据ASD的诊断标准分为ASD组和非ASD组,两组进行BAEP、CARS、ABC检测,并分析各单项及联合指标的诊断效能。结果ASD组BAEP异常率为74.00%(37/50),非ASD组为29.63%(8/27),两组差异有统计学意义(χ^(2)=14.212,P<0.05);ASD组CARS、ABC得分显著高于非ASD组(t值分别为4.080、2.160,P<0.05)。单项检测中,诊断特异度由高到低依次为BAEP(70.37%)、CARS(62.96%)、ABC(48.15%),CARS的灵敏度(92.00%)、约登指数(0.55)、Kappa值(0.579)及ROC曲线下面积(AUC,0.766)均优于BAEP、ABC。BAEP+CARS联合检测的约登指数(0.59)、AUC(0.793)显著高于单项和其他联合检测(P<0.05)。结论与CARS、ABC相比,BAEP诊断特异性更高,BAEP+CARS联合检测有利于提高ASD的诊断价值,为ASD早期诊断提供客观依据。

Objective To investigate application value of brainstem auditory evoked potentials(BAEP),childhood autism rating scale(CARS)and autism behavior checklist(ABC)in diagnosis of autism spectrum disorder(ASD)in children.Methods A total of 77 children with suspected ASD who admitted to Department of Child Health,Hubei Provincial Maternal and Child Health Hospital from January 2020 to June 2022 were selected as study subjects and were divided into ASD group and non-ASD group according to diagnostic criteria of ASD.The children in the two groups received BAEP,CARS and ABC examinations,and the diagnostic values of single index and combined indexes were analyzed.Results The abnormal rate of BAEP was 74.00%(37/50)in the ASD group and 29.63%(8/27)in the non-ASD group,and the difference was statistically significant(χ^(2)=14.212,P<0.05).The scores in CARS and ABC of the children in the ASD group were significantly higher than those in the non-ASD group,and the differences were significant(t=4.08 and 2.16respectively,both P<0.05).For single index,the diagnostic specificity of BAEP for ASD was 70.37%,that of CARS was 62.96%and that of ABC was 48.15%in on order from high to low,and CARS was better than BAEP and ABC in sensitivity(92.00%),Youden index(0.55),Kappa value(0.579)and area under ROC curve AUC(0.766).Youden index(0.59)and AUC(0.793)of BAEP+CARS combination were significantly higher than those of single index and other combinations(both P<0.05).Conclusion Compared with CARS and ABC,BAEP has higher diagnostic specificity for ASD in children.The combination of BAEP+CARS is beneficial to improve diagnostic value for ASD and provide an objective basis for early diagnosis of ASD.