孤独症儿童的家庭管理特征潜在类别及其影响因素分析

目的识别并描述孤独症儿童家庭管理特征的潜在类别及其主要影响因素。方法便利抽样法选取广州市某三级甲等医院儿童行为发育中心门诊就诊的328名孤独症儿童父母为研究对象,采用一般资料调查表及慢性病儿童家庭管理量表对其进行调查,使用潜在剖面分析方法识别孤独症儿童家庭管理特征的潜在类别,并采用多元Logistic回归分析不同类别的影响因素。结果孤独症儿童的家庭管理特征可分为“管理有效型”(16.2%)、“基本适应型”(52.7%)及“管理困难型”(31.1%),确诊时间、居住地、经济水平、孤独症专业干预情况、父母健康和参与干预情况是家庭管理特征潜在类别的影响因素(均P<0.05)。结论大部分孤独症儿童的家庭管理存在不同程度的困难,应关注确诊时间长、居住于农村、经济收入低家庭的孤独症儿童照护与干预情况,重视孤独症儿童父母的健康状况,为孤独症儿童接受专业干预提供支持。

Prevalence of Autism Spectrum Disorder in China:A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years

This study aimed to obtain the first national estimate of the prevalence of autism spectrum disorder(ASD) in Chinese children.We targeted the population of 6 to 12-year-old children for this prevalence study by multistage convenient cluster sampling.The Modified Chinese Autism Spectrum Rating Scale was used for the screening process.Of the target population of 142,086 children,88.5%(n=125,806) participated in the study.A total of 363 children were confirmed as having ASD.The observed ASD prevalence rate was 0.29%(95% CI:0.26%-0.32%) for the overall population.After adjustment for response rates,the estimated number of ASD cases was867 in the target population sample,thereby achieving an estimated prevalence of 0.70%(95% CI:0.64%-0.74%).The prevalence was significantly higher in boys than in girls(0.95%;95% CI:0.87%-1.02% versus 0.30%;95%CI:0.26%-0.34%;P <0.001).Of the 363 confirmed ASD cases,43.3% were newly diagnosed,and most of those(90.4%) were attending regular schools,and 68.8% of the children with ASD had at least one neuropsychiatric comorbidity.Our findings provide reliable data on the estimated ASD prevalence and comorbidities in Chinese children.

基于PEP-3的小头围孤独症谱系障碍儿童的临床特征分析

目的探讨小头围孤独症谱系障碍(autism spectrum disorder,ASD)儿童的临床特征及其可能存在的临床意义。方法回顾33例小头围ASD住院儿童的病例资料,根据自闭症儿童心理教育评核第3版(PEP-3)结果对临床特征进行总结。并分析比较男童(n=20)与女童(n=13)、轻度小头围(n=18)与重度小头围(n=15)儿童的PEP-3各副测验的评估结果。结果(1)在PEP-3各副测验中,小头围ASD儿童在恰当、轻度、中度、重度等病情程度的构成比分别为:认知,0.00%、12.12%、42.42%、45.45%;语言表达,3.03%、6.06%、51.52%、39.39%;语言理解,0.00%、6.06%、54.55%、39.39%;小肌肉,3.03%、0.00%、51.52%、45.45%;大肌肉,3.03%、9.09%、48.48%、39.39%;模仿,0.00%、9.09%、60.61%、30.30%;情感表达,3.03%、3.03%、57.58%、36.36%;社会互动,3.03%、9.09%、48.48%、39.39%;行为特征-非语言,9.09%、9.09%、54.55%、27.27%;行为特征-语言,3.03%、6.06%、48.48%、42.42%。(2)男童组与女童组PEP-3各副测验的百分比级数比较差异无统计学意义(均P>0.05)。(3)重度小头围组儿童PEP-3副测验中的认知、大肌肉百分比级数低于轻度小头围组(均P<0.05)。结论(1)小头围ASD儿童存在临床异质性,病情以中到重度为主。(2)小头围ASD儿童的PEP-3各副测验结果不存在性别差异。(3)重度小头围ASD儿童的大运动水平和认知水平较轻度小头围ASD儿童低。

孤独症谱系障碍与母亲孕期增重、孕前BMI的关联性研究

目的探讨母亲孕期增重、孕前BMI与中国广东汉族人群子代孤独症谱系障碍(autism spectrum disorder,ASD)的关联性及其可能存在的临床意义。方法选取ASD患儿279例、其发育正常同胞25例及年龄匹配的发育正常儿童139例,完善其围产期资料及母亲孕产期资料,并进行统计学分析。结果1)在ASD患儿及其发育正常同胞对照中,母亲2次妊娠期间孕期增重(t=1.221,P=0.234)、孕前体重指数(body mass index,BMI)(t=0.715,P=0.482)差异无统计学意义,校正母亲生产年龄及孕前BMI(或孕期增重)等混杂因素后,2组孕期增重(F=0.024,P=0.878)或孕前BMI(F=0.002,P=0.961)间差异亦无统计学意义。2)ASD患儿及发育正常儿童母亲孕期增重(t=-0.390,P=0.696)、孕前BMI(t=0.715,P=0.482)间的差异无统计学意义,对混杂因素进行校正后,2组母亲孕期增重(F=0.374,P=0.541)或孕前BMI(F=0.016,P=0.898)间的差异无统计学意义。结论母亲孕期增重及孕前BMI可能与中国广东汉族人群子代ASD的发病无显著相关。

Biomarkers of preschool children with autism spectrum disorder:quantitative analysis of whole-brain tissue component volumes,intelligence scores,ADOS-CSS,and ages of first-word production and walking onset

Background Preschooling is a critical time for intervention in children with autism spectrum disorder(ASD);thus,we analyzed brain tissue component volumes(BTCVs)and clinical indicators in preschool children with ASD to identify new biomarkers for early screening.Methods Eighty preschool children(3–6 years)with ASD were retrospectively included.The whole-brain myelin content(MyC),white matter(WM),gray matter(GM),cerebrospinal fluid(CSF),and non-WM/GM/MyC/CSF brain component volumes were obtained using synthetic magnetic resonance imaging(SyMRI).Clinical data,such as intelligence scores,autism diagnostic observation schedule-calibrated severity scores,age at first production of single words(AFSW),age at first production of phrases(AFP),and age at walking onset(AWO),were also collected.The correlation between the BTCV and clinical data was evaluated,and the effect of BTCVs on clinical data was assessed by a regression model.Results WM and GM volumes were positively correlated with intelligence scores(both P<0.001),but WM and GM did not affect intelligence scores(P=0.116,P=0.290).AWO was positively correlated with AFSW and AFP(both P<0.001).The multivariate linear regression analysis revealed that MyC,AFSW,AFP,and AWO were significantly different(P=0.005,P<0.001,P<0.001).Conclusions This study revealed positive correlations between WM and GM volumes and intelligence scores.Whole-brain MyC affected AFSW,AFP,and AWO in preschool children with ASD.Noninvasive quantification of BTCVs via SyMRI revealed a new visualizable and quantifiable biomarker(abnormal MyC)for early ASD screening in preschool children.

KMT2D deficiency leads to cellular developmental disorders and enhancer dysregulation in neural-crest-containing brain organoids

KMT2D,a H3K4me1 methyltransferase primarily regulating enhancers,is a leading cause of KABUKI syndrome.This multisystem disorder leads to craniofacial and cognitive abnormalities,possibly through neural crest and neuronal lineages.However,the impacted cell-of-origin and molecular mechanism of KMT2D during the development of KABUKI disease remains unknown.Here we have optimized a brain organoid model to investigate neural crest and neuronal differentiation.To pinpoint KMT2D's enhancer target,we developed a genome-wide cis-regulatory element explorer(GREE)based on single-cell multiomic integration.Single cell RNA-seq revealed that KMT2D-knockout(KO)and patient-derived organoids exhibited neural crest deformities and GABAergic overproduction.Mechanistically,GREE identified that KMT2D targets a roof-plate-like niche cell and activates the niche cell-specific WNT3A enhancer,providing the microenvironment for neural crest and neuronal development.Interestingly,KMT2D-mutated mice displayed decreased WNT3A expression in the diencephalon roof plate,indicating impaired niche cell function.Deleting the WNT3A enhancer in the organoids presented phenotypic similarities to KMT2D-depletion,emphasizing the WNT3A enhancer as the predominant target of KMT2D.Conversely,reactivating WNT signaling in KMT2D-KO rescued the lineage defects by restoring the microenvironment.Overall,our discovery of KMT2D's primary target provides insights for reconciling complex phenotypes of KABUKI syndrome and establishes a new paradigm for dissecting the mechanisms of genetic disorders from genotype to phenotype.

Eye movements characteristics of Chinese dyslexic children in picture searching

Background Reading Chinese, a kind of ideogram, relies more on visual cognition. The visuospatial cognitive deficit of Chinese dyslexia is an interesting topic that has received much attention. The purpose of current research was to explore the visuopatial cognitive characteristics of Chinese dyslexic children by studying their eye movements via a picture searching test. Methods According to the diagnostic criteria defined by ICD-10, twenty-eight dyslexic children （mean age （10.12±1.42） years） were enrolled from the Clinic of Children Behavioral Disorder in the third affiliated hospital of Sun Yat-sen University. And 28 normally reading children （mean age （10.06±1.29） years）, 1：1 matched by age, sex, grade and family condition were chosen from an elementary school in Guangzhou as a control group. Four groups of pictures （cock, accident, canyon, meditate） from Picture Vocabulary Test were chosen as eye movement experiment targets. All the subjects carried out the picture searching task and their eye movement data were recorded by an Eyelink II High-Speed Eye Tracker. The duration time, average fixation duration, average saccade amplitude, fixation counts and saccade counts were compared between the two groups of children. Results The dyslexic children had longer total fixation duration and average fixation duration （F=-7.711, P 〈0.01; F=-4.520, P 〈0.05）, more fixation counts and saccade counts （F=-7.498, P 〈0.01; F=-11.040, P 〈0.01）, and a smaller average saccade amplitude （F=-29.743, P 〈0.01） compared with controls. But their performance in the picture vocabulary test was the same as those of the control group. The eye movement indexes were affected by the difficulty of the pictures and words, all eye movement indexes, except saccade amplitude, had a significant difference within groups （P 〈0.05）. Conclusions Chinese dyslexic children have abnormal eye movements in picture searching, applying slow fixations, more fixations and small and frequent saccades. Their abnormal eye movement mode reflects the poor ability and strategy of visual information processing.

Sex Differences in Diagnosis and Clinical Phenotypes of Chinese Children with Autism Spectrum Disorder

The aim of this study was to explore the differences between boys and girls in the diagnosis and clinical phenotypes of autism spectrum disorder（ASD） in China＇s mainland. Children diagnosed with ASD（n = 1064, 228 females） were retrospectively included in the analysis. All children were assessed using the Autism Diagnostic Interview-Revised（ADI-R） and Autism Diagnostic Observation Schedule（ADOS）. The results showed that girls scored significantly higher in ADI-R socioemotional reciprocity than boys, and also scored lower in ADI-R and ADOS restricted and repetitive behaviors（RRBs）. Meanwhile, the proportions of girls who satisfied the diagnostic cut-off scores in the ADI-R RRBs domain were lower than in boys（P ／ 0.05）. Our results indicated that girls with ASD show greater socio-emotional reciprocity than boys. Girls also tended to show fewer RRBs than boys, and the type of RRBs in girls differ from those in boys. The ADI-R was found to be less sensitive in girls, particularly for assessment in the RRBs domain.

语言流畅孤独症谱系障碍儿童核心症状与智商关系研究

目的 探究6~18岁语言流畅的孤独症谱系障碍(autism spectrum disorders,ASD)儿童核心症状与智商(intelligence quotient,IQ)之间的关系,为ASD儿童的个性化干预目标制定提供参考。方法 选取2019年4月至2022年5月中山大学附属第三医院儿童发育行为中心语言流畅且符合《美国精神障碍诊断与统计手册》第5版(DSM-Ⅴ)诊断标准的6~18岁ASD患儿(183例)为观察组,另选取同期体检正常儿童(91名)为对照组。使用孤独症诊断观察量表(ADOS,单元三)对ASD核心症状进行量化评分,并用韦氏儿童智力量表第4版(中文版)(WISC-Ⅳ)测定所有被试儿童的IQ。采用Pearson相关分析对孤独症核心症状与IQ关系进行探索。结果 6~18岁语言流畅ASD儿童总IQ、言语理解、知觉推理、工作记忆及加工速度指数均低于正常儿童,差异均有统计学意义(均P<0.05)。61.7%的ASD IQ处于平均智力水平,27.9%低于平均水平。在总IQ、言语理解、工作记忆、加工速度方面,ASD及正常儿童性别差异均无统计学意义(均P>0.05)。在知觉推理方面,ASD男性儿童分数高于女性,差异有统计学意义(P<0.05),而正常儿童差异无统计学意义。ASD不同年龄及不同性别间,ADOS沟通分数、社会互动分数、沟通+社会互动分数、刻板分数间差异无统计学意义(均P>0.05)。ADOS沟通分数、社会互动分数及沟通+社会互动总分数与总IQ均呈负相关关系(r=-0.43,P<0.01;r=-0.31,P<0.01;r=-0.40,P<0.01),而ADOS刻板分数与总IQ相关关系无统计学意义(r=-0.10,P=0.20)。结论 ASD儿童平均总IQ及各功能区分数均落后于正常儿童,个体间总IQ差异较大,知觉推理能力存在性别差异。不同年龄、不同性别ASD儿童ADOS各领域分数差异无统计学意义,需要针对社交沟通、社会互动等方面缺陷进行持续支持。ASD儿童核心症状与其IQ负相关,提示在临床实践中,应针对ASD核心缺陷进行干预。

胎龄、出生体重与孤独症谱系障碍的相关性研究

目的探讨胎龄、出生体重及胎龄别出生体重与孤独症谱系障碍（Autism spectrum disorder，ASD）发生的相关性，及其对ASD儿童早期发展的影响。方法运用自编出生情况调查问卷收集572例ASD组和707例对照组儿童出生情况资料，分析胎龄、出生体重及胎龄别出生体重与ASD相关性；随机抽取≤6岁ASD儿童134例进行婴幼儿发育检查量表评估，分析各能区发育商与出生情况的相关性。结果（1）ASD组[〈37周：37例（6．5％），≥37周：535例（93．5％）]与对照组[〈37周：39例（5．5％），≥37周：668例（94．5％）]胎龄构成比差异无统计学意义（Х^2=0．513，P=0．747）；ASD组[〈2500g：26例（4．5％），2500～4000g：528例（92．3％），〉4000g：18例（3．1％）]与对照组[〈2500g：31例（4．4％），2500-4000g：650例（91．9％），〉4000g：26例（3．7％）]出生体重构成比差异无统计学意义（Х^2=0．282，P=0．869）；（2）Logistic回归分析显示，小于胎龄儿（small for gestational age，SGA）（B=0．370，OR=2．384，95％CI：1．436—3．958，P=0．001）是ASD发生的危险因素。（3）多元线性回归分析显示出生体重是ASD儿童个人社会能区发育商的影响因素（P=0．037）。结论SGA与ASD发生存在相关性，ASD儿童社交功能水平与其出生体重相关。减少产前高危因素对减少ASD的发生或减轻ASD社交障碍可能有意义。

长期居家学习期间儿童和青少年心理行为问题的研究

目的研究新型冠状病毒肺炎(COVID-19)大流行期间长期居家学习的不同年龄和性别儿童青少年的心理行为问题特点及影响因素,为今后进行更有针对性的心理干预和社会支持提供科学依据。方法横断面研究。采用网络问卷调查的方式,对我国的地理区域北部(北京)、东部(上海)、西部(重庆)、南部(广州)和中部(武汉)的5个不同地域的代表性城市中6~16岁儿童和青少年在长期居家学习期间的社会行为和心理问题进行多维度调查,以任一维度阳性作为存在心理行为问题,采用Logistic回归分析心理行为问题的危险因素,并对混杂因素进行逐级校正。结果共收到有效问卷6906份。其中男3592人、女3314人,6~11岁组3626人,12~16岁组3280人。心理行为问题的总阳性检出率为13.0%(900/6906),男童为9.6%(344/3592)、女童为16.8%(556/3314);其中6~11岁组男童为7.3%(142/1946)、女童为14.0%(235/1680);12~16岁组男童为12.3%(202/1646)、女童为19.6%(321/1634)。心理行为问题阳性组在性别、亲子冲突、好朋友数量、家庭收入变化、久坐时间、家庭作业时间、屏幕暴露时间、体育活动时间、饮食问题(χ^(2)=78.851、285.264、52.839、26.284、22.778、11.024、10.688、36.814、70.982,均P<0.001)等方面与阴性组间存在明显差异。不同年龄和性别儿童与青少年组心理行为问题表现不同,6~11岁男孩为强迫性、分裂样和抑郁;6~11岁女孩为分裂强迫、多动和社交退缩;12~16岁男孩为多动、强迫性和攻击性;12~16岁女孩为分裂样、焦虑强迫和抑郁退缩。多因素校正及分析发现,不同年龄组除了共性的风险因素外,作业时间、网课时间是6~11岁组的危险因素[男童OR(95%CI)分别为1.750(1.32~2.32)、1.214(1.00~1.47),女童OR(95%CI)分别为1.579(1.25~1.99)、1.222(1.05~1.42),P均<0.05],电子游戏时间是12~16岁组的危险因素[男童OR(95%CI)为2.237(1.60~3.13),女童OR(95%CI)为1.272(1.00~1.61),P均<0.05]。结论长期居家学习期间部分儿童青少年可能会产生心理行为问题,不同年龄和性别组的异常表现和影响因素并不完全相同。学校、家庭和专科医生应针对不同年龄性别特点和相应的风险因素积极给予更精准的心理支持和综合干预策略。

孤独症谱系障碍儿童喂养问题现况调查及其相关因素分析

目的分析孤独症谱系障碍(ASD)儿童中喂养问题的现状及ASD儿童喂养问题的相关因素,为临床指导ASD儿童喂养问题的行为矫正提供理论依据。方法于2015年8月—2016年1月通过收集119例ASD儿童和185名正常儿童的进食行为量表(BAMBI)得分来比较两组在喂养问题上的差异,采用Spearman秩相关分析喂养问题的相关因素。结果ASD男童的拒绝进食行为、食物谱狭窄和BAMBI总分均高于正常男童(9.64±3.18vs.8.15±2.85,P=0.003;21.21±5.53vs.18.76±4.93,P=0.004;41.44±9.41vs.37.05±7.41,P=0.001),ASD女童的孤独症特征相关的喂养问题得分明显高于ASD男童(12.17±2.25vs.10.58±2.60,P=0.029)。低功能ASD男童拒绝进食行为得分、孤独症特征相关的喂养问题得分和BAMBI总分均高于正常男童(9.83±3.21vs.7.61±2.56,P=0.004;11.72±3.03vs.10.07±2.31,P=0.029;42.62±10.54vs.36.89±7.41,P=0.028)。ASD儿童中,拒绝进食行为得分与刻板行为、自伤行为、强迫行为、仪式单调行为、受限行为得分呈正相关(P<0.05);孤独症特征相关的喂养问题得分与年龄、刻板行为、仪式单调行为、受限行为得分呈正相关(P<0.05);食物谱狭窄得分与刻板行为、强迫行为、仪式单调行为、受限行为得分呈正相关(P<0.05)。结论ASD男童较正常男童存在更多的喂养问题,低功能ASD男童的喂养问题可能受重复刻板行为影响,临床工作者需给予更多的关注,并进行个体化的行为矫正。

3～7岁孤独症谱系障碍儿童的气质特点研究

目的研究3~7岁孤独症谱系障碍(ASD)儿童的气质特点,为其识别、干预提供依据。方法选择2012年10月—2013年3月在中山大学附属第三医院儿童发育行为中心确诊的3~7岁的130例ASD儿童,与我国正常同龄儿童气质常模进行对比,对ASD儿童的气质特点进行研究。结果 3~7岁ASD儿童气质以I-E型为主,但所占比例较正常学龄前儿童明显下降。其气质维度明显异于正常同龄儿童(P<0.05);3~7岁ASD儿童的气质类型的性别之间差异明显,男童的反应阈维度得分高(P<0.05),其余气质维度得分无明显性别差异,且反应强度与月龄呈负相关(r=-0.19,P<0.05);3~7岁ASD儿童的适应性、反应强度、心境得分与出生体重负相关(r=-0.26、-0.32、-0.31,P均<0.01)。结论 3~7岁ASD儿童气质维度明显异于正常同龄儿童,对其进行研究可更好地发现以及干预ASD。

孤独症谱系障碍干预原则与BSR模式

孤独症谱系障碍(ASD)以社交障碍、狭隘兴趣与刻板行为为主要特征。有充分的研究证据表明早期诊断、早期干预可以显著改善ASD不良预后。根据我国国情,ASD干预必须以社会交往缺陷作为干预的核心任务,坚持科学循证干预、个性化干预和家庭及社区为基地的干预,作者据此提出ASD教育三原则和以行为疗法为基本手段;以结构化教育作为干预基本框架;以人际发展社会交往作为干预的基本内容的BSR模式。

行为-结构化-关系干预模式对短期住院孤独症谱系障碍儿童的疗效分析

目的探讨以行为-结构化-关系(BSR)干预模式对短期住院孤独症谱系障碍(ASD)儿童的干预疗效,为改善ASD儿童的预后提供参考依据。方法选取2015年12月-2016年12月确诊为ASD的2~6岁儿童141例,随机分为治疗组和对照组。治疗组ASD儿童均接受BSR模式的短期课程训练,训练课程包括个别辅导、游戏课、运动课、音乐课等,每天训练时间6h,持续1个月;对照组ASD儿童处于干预等待,接受随访观察和评估。所有ASD儿童干预前、后均接受儿童心理教育评估(第三版)(PEP-3)来进行各方面能力变化的评估。结果治疗组、对照组干预前各副测验的原积分差异无统计学意义(P>0.05)。两组ASD儿童干预后认知、语言理解、模仿、情感表达、社会互动、行为特征-非语言、适应行为的原积分比较,差异均有统计学意义(t=2.41、2.02、4.14、3.69、4.42、2.69、2.96,P<0.05);但小肌肉、大肌肉、自理的原积分比较,差异无统计学意义(t=-1.13、-1.05、-0.84,P>0.05)。结论BSR干预模式能够有效改善短期住院ASD儿童的预后,可推广用于儿童ASD的治疗。

Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder:a longitudinal study

Background Several studies have shown the effectiveness of the Early Start Denver Model(ESDM),but few studies have explored the long-term efficacy of ESDM.This study aimed to explore the efficacy and moderating factors of ESDM in Chinese toddlers with autism spectrum disorder(ASD)in a longitudinal way.Methods A total of 60 toddlers with ASD were recruited and randomly divided into two groups:ESDM group all received 24 weeks intervention;Control group were waiting for intervention.Baseline assessment(T0)was conducted before intervention,including Gesell Developmental Scale(GDS)and Psycho-educational Profile-3rd Edition(PEP-3).All toddlers with ASD were examined in the first assessment(T1)at 6 months and in the second assessment(T2)at 12 months.Results In T1 assessment,the increments in speech and personal communication development quotient in GDS were significantly larger in the ESDM group than in the control group(P=0.010,0.047).In T2 assessment,the ESDM group had higher elevation in cognitive verbal/preverbal(CVP),social reciprocity and characteristic verbal behaviors assessed by PEP-3(P=0.021,0.046,0.014).In addition,the severity of stereotyped behavior was negatively associated with improvement in CVP.Family income was positively associated with improvement in speech and CVP(all P<0.05).Conclusions ESDM can effectively improve speech and communication in toddlers with ASD after 24-week intervention.More importantly,ESDM can promote cognition and social interaction and can reduce stereotyped verbal behavior in toddlers with ASD in longitudinal observation.The severity of stereotyped behavior and family ecological factors may be considered as affecting the efficacy of ESDM.

早期介入丹佛模式对孤独症谱系障碍婴幼儿的疗效分析

目的探讨早期介入丹佛模式(ESDM)对孤独症谱系障碍(ASD)婴幼儿干预效果,为改善ASD预后提供依据。方法招募2015年6月—2017年6月中山大学附属第三医院儿童发育行为中心临床诊断为ASD的婴幼儿60例。随机分为两组:实验组30例,均接受ESDM干预;对照组30例,为干预等待的ASD婴幼儿。干预时间为每周1次,每次1 h,持续24周。干预前进行基线系统评估,干预后两组均完成儿童心理教育评估(PEP-3)、Gesell量表评估。结果 ESDM组和对照组月龄、性别差异无统计学意义,干预前两组沟通、社交互动、重复刻板行为、认知、语言、精细动作差异亦无统计学意义(P>0.05)。干预后ESDM组语言、个人-社交较对照组明显提高,差异具有统计学意义(t=2.215、2.379,P<0.05);ESDM组认知、语言表达、语言理解、小肌肉、模仿、行为特征-非语言的原积分较对照组明显提升,差异有统计学意义(t=2.336、2.510、2.416、2.578、2.017、2.150,P<0.05)。此外,ESDM组Gesell量表中的语言发育商干预前后的差值高于对照组,差异有统计学意义(Z=2.105,P<0.05)。结论经ESDM模式干预后,ASD婴幼儿语言、社交明显改善,认知、语言表达、语言理解、小肌肉、模仿能力明显提升,行为特征-非语言的刻板行为明显减少。

共同注意在孤独症谱系障碍幼儿早期识别中的应用

目的对孤独症谱系障碍(ASD)幼儿共同注意(JA)行为特征进行分析,为早期识别及早期诊断提供理论依据。方法采用视频分析的方式,于2017年4—12月由两位专业人员对61例16~30月幼儿的共同注意行为进行评估,与同龄正常发育(NT,n=33)幼儿及发育迟缓(DD,n=32)幼儿进行对比,并根据有差异的行为指标进行诊断预测。结果ASD幼儿自发性共同注意(IJA)行为出现的次数及响应性共同注意(RJA)得分均较DD组及NT组幼儿低,差异有统计学意义(P<0.05);而DD与NT幼儿在各JA行为指标方面差异均无统计学意义。当联合所有JA指标从全部幼儿中识别ASD时,受试者工作特征曲线下面积为0.891(P<0.01)。结论 ASD幼儿在各种共同注意行为方面与DD及NT幼儿均存在明显差异。共同注意在ASD幼儿的早期识别中具有重要应用价值。

叫名反应在孤独症谱系障碍幼儿早期识别中的应用

目的探讨16~30月龄孤独症谱系障碍(ASD)幼儿在叫名反应情景中的行为特征,为早期识别及早期诊断提供理论依据。方法采用视频分析的方式,由2位专业人员根据评分标准对2017年4月至12月中山大学附属第三医院儿童发育行为中心确诊的ASD幼儿(ASD组,61例)在叫名反应情境中的反应得分(RS)、反应时间(RT)、反应后持续时间(DT)及反应率(RR)进行评估,并与同年龄正常发育儿童(NT组,33例)及发育迟缓儿童(DD组,32例)进行对比,根据组间有差异的行为指标对ASD进行诊断预测。结果与DD组[RS2(1)分,RT1.32(4.65)s,DT2.69(1.84)s]及NT组[RS2(1)分,RT1.37(4.37)s,DT2.90(2.23)s]比较,ASD组患儿的RS[1(1)分]均较低、RT[5.87(4.64)s]均较长、DT[0.77(1.88)s]均较短,差异均有统计学意义(H=-4.91、-5.94,5.36、5.41,-4.47、-5.78,均P<0.05);而DD组与NT组比较差异均无统计学意义(均P>0.05)。与NT组[0.75(0.50)]相比,ASD组[0.25(0.50)]及DD组[0.50(0.25)]的RR均较低,差异有统计学意义(H=-6.39、-4.45,均P<0.01);而ASD组与DD组比较差异无统计学意义(P>0.05)。根据叫名反应各指标从NT幼儿与ASD幼儿中识别ASD时,受试者工作特征曲线下面积(AUC)为0.889,P<0.01;从DD与ASD幼儿中识别ASD时,AUC为0.924,P<0.01;从全部幼儿中识别ASD时,AUC为0.868,P<0.01。结论ASD幼儿在叫名反应方面与DD及NT幼儿存在明显差异。根据儿童早期在叫名反应情境中的行为特征可较好地对ASD进行预测。叫名反应作为一种早期社交行为指标,在2岁左右时对ASD早期识别及早期诊断仍具有重要意义。

系统性炎症反应指数与卒中后抑郁的关系:基于倾向评分匹配及逆概率处理加权法

目的基于倾向评分匹配(PSM)和逆概率处理加权法(IPTW)探讨系统性炎症反应指数(SIRI)与卒中后抑郁(PSD)的关系。方法选取2007—2018年美国国家健康和营养检查调查(NHANES)数据库中自我报告的年龄>20岁的脑卒中患者1016例为研究对象,收集患者的临床资料、计算SIRI。采用患者健康问卷(PHQ-9)评估脑卒中患者的抑郁症情况。采用PSM和IPTW控制混杂因素,采用标准化均数差(SMD)评估低SIRI组与高SIRI组各协变量的均衡性,以SMD<0.1为组间均衡性较好;采用多因素Logistic回归分析探讨SIRI与PSD的关系,采用亚组分析探讨不同特征患者中SIRI与PSD的关系。结果1016例脑卒中患者中,189例(18.60%)合并抑郁症(PSD组),827例(81.40%)未合并抑郁症(非PSD组)。PSD组与非PSD组性别、年龄、BMI、婚姻状况、吸烟史、心血管疾病史比较,差异有统计学意义(P<0.05)。患者的SIRI为1.2×10^(9)(0.8×10^(9),1.9×10^(9))。根据SIRI诊断PSD的最佳截断值将患者分为低SIRI组(SIRI<1.5×10^(9),n=627)和高SIRI组(SIRI≥1.5×10^(9),n=389),采用PSM处理后低SIRI组和高SIRI组各389例,采用IPTW处理后低SIRI组和高SIRI组各1015例。匹配前低SIRI组与高SIRI组性别、年龄、受教育程度、吸烟史、高血压史、糖尿病史、心血管疾病史比较,差异有统计学意义(P<0.05)。PSM、IPTW处理后低SIRI组与高SIRI组性别、年龄、BMI、受教育程度、婚姻状况、吸烟史、饮酒史、高血压史、糖尿病史、心血管疾病史比较,差异无统计学意义(P>0.05)。匹配前低SIRI组和高SIRI组性别、年龄、BMI、受教育程度、婚姻状况、吸烟史、饮酒史、高血压史、糖尿病史、心血管疾病史SMD>0.1;PSM处理后低SIRI组和高SIRI组受教育程度、心血管疾病史SMD=0.1,性别、年龄、BMI、婚姻状况、吸烟史、饮酒史、高血压史、糖尿病史SMD<0.1;IPTW处理后低SIRI组和高SIRI组性别、年龄、BMI、受教育程度、婚姻状况、吸烟史、饮酒史、高血压史、糖尿病史、心血管疾病史SMD<0.1。多因素Logistic回归分析结果显示,匹配前SIRI与PSD不相关〔OR=1.298,95%CI(0.941,1.787),P=0.111〕;PSM处理后,SIRI≥1.5×10^(9)是PSD的独立危险因素〔OR=1.556,95%CI(1.075,2.265),P=0.020〕;IPTW处理后,SIRI≥1.5×10^(9)是PSD的独立危险因素〔OR=1.444,95%CI(1.158,1.805),P<0.001〕。亚组分析结果显示,在男性、年龄<60岁、BMI≥30 kg/m^(2)、有高血压史、有心血管疾病史患者中,SIRI≥1.5×10^(9)是PSD的独立危险因素(P<0.05)。交互作用检验结果显示,年龄可能是影响SIRI与PSD关系的因素(P<0.05)。结论SIRI≥1.5×10^(9)是PSD的独立危险因素,尤其在男性、年龄<60岁、BMI≥30 kg/m2、有高血压史、有心血管疾病史的脑卒中患者中。SIRI可作为PSD的辅助诊断标志物,以帮助临床医生早期对PSD做出诊断。