重症肌无力严重程度量表的评价  

Evaluation of the scales assessing the severity of myasthenia gravis

作　　者：高翔[1] 张栩[1] 杨欢[3] 周红雨[4] 谢琰臣[5] 邱伟[6] 肖丽[6] 王任华[4] 夏梦[1] 王琳[2] 李海峰[7] 

机构地区：[1]青岛大学附属医院神经内科,山东省青岛市266000 [2]青岛大学附属医院康复医学二科,山东省青岛市266000 [3]中南大学湘雅医院神经内科 [4]四川大学华西医院神经内科 [5]首都医科大学附属北京友谊医院神经内科 [6]中山大学附属第三医院神经内科 [7]山东大学齐鲁医院神经内科

出　　处：《中华神经科杂志》2016年第5期375-381,共7页Chinese Journal of Neurology

基　　金：国家自然科学基金面上项目（81070963）;山东省自然科学基金面上项目（ZR2010HM019）

摘　　要：目的评价4个常用的重症肌无力（MG）严重程度量表在中国MG患者中的信度和效度。方法选取60例MG患者，由同一名检查者完成重症肌无力定量评分（QMGS）、重症肌无力复合量表（MGC）、肌无力肌肉量表（MMS）、重症肌无力绝对和相对评分法（ARS—MG）的检查并录像，患者进行MG日常生活量表（MG—ADL）白评。首次检查后24h由同一位检查者再次检查患者。另外5名MG专业医师通过独立观看录像而评分。用加权Kappa检验评价各量表每个条目的观察者间信度；用Cronbach0系数评价量表的内部一致性；用组内相关系数（ICC）评价量表的重测信度和观察者间信度；用因子分析法评价量表的结构效度；用Spearman相关系数评价校标关联效度和量表之间的相关性。结果量表各条目的观察者间信度较好（k为0．310～0．891，P〈0．01）。4个MG量表的内部一致性好（CronbachQ为0．701—0．734），量表的重测信度（ICC0．887～0．948，P〈0．01）和观察者间信度（ICC0．853～0．917，P〈0．01）均很好。因子分析法显示4个量表各有3～4项公因子，累积方差贡献率66．49％～72．64％，结构效度良好。校标QMGS与其他3个量表分别存在中度到高度的相关性（r为0．792～0．840，P〈0．01）；校标MG—ADL与4个量表均有中度相关性（r为0．693—0．766，P〈0．01）。结论4个MG严重程度量表具有良好的信度和效度，均能可靠有效地评价MG的严重程度。Objective To evaluate the reliability and validity of the 4 myasthenia gravis （MG） scales widely used for assessing the grades of disease severity in Chinese MG patients. Methods Sixty MG patients were examined by a neurologist with the following four MG scales： Quantitative Myasthenia Gravis Score （QMGS）, Myasthenia Gravis Composite （MGC）, Myasthenic Muscle Scale （MMS）, Absolute and Relative Score of MG （ARS-MG）. The whole assessment process was videotaped. MG Activities of Daily Living （MG-ADL） score was acquired after the examination. The patients were examined by the same neurologist with the same MG scales within 24 hours after the first examination. The original videotapes of each patient were assessed by five other neurologists independently. Interabserver reliability of each item of the four MG scales was assessed with weighted Kappa test. Internal consistency of the scales was assessed with Cronbaeh a. Test-retest reliability and interobserver reliability among the five neurologists were assessed with intraelass correlation coefficience （ICC）. The construct validity was assessed with factor analysis. Criterion validity was assessed by Spearman correlation analysis. Results Interobserver reliability of items of the 4 MG scales was moderate （k 0. 310-0. 891, P〈0. 01 ）. All 4 MG scales showed good internal consistency （ Cronbach a 0. 701 - 0. 734） with high test-retest reliability （ ICC 0. 887 - 0. 948, P 〈 0. 01 ） and interobserver reliability （ICC 0. 853 -0. 917, P 〈 0. 01 ）. Factor analysis showed good construct validity （accumulative dedication rate 66.49% -72. 64% ）. There was moderate to strong correlation between QMGS （as criterion） and the other three scales （ r 0. 792 - 0. 840, P 〈 0. 01 ）, and moderate correlation between MG-ADL （as criterion） and the four scales （r 0. 693 - 0. 766, P 〈 0. 01 ）. Conclusion The 4 widely used MG severity scales can effectively assess the grades of disease severity of MG with good reliability

关 键 词：重症肌无力 评价研究 可重复性 结果 有效性研究 

分 类 号：R746.1[医药卫生—神经病学与精神病学]