孤独症谱系障碍患儿临床特点及发病影响因素的病例对照研究  

Case -control study on clinical features and influencing factors of children with autism spectrum disorders

作　　者：何玉莹 杨莹一 邵冬冬[2] 陈希蕊 贺莉[2] 张婕[2] 陈艳妮[2] 

机构地区：[1]西安市妇幼保健院儿童保健科,710002 [2]西安市儿童医院儿童保健科,710003

出　　处：《中华实用儿科临床杂志》2017年第8期607-612,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金面上项目（81371900）;陕西省自然科学基础研究计划项目（2009JM4030）

摘　　要：目的 探讨孤独症谱系障碍（ASD）患儿的早期临床特点及发病影响因素。方法 2005年1月至2014年12月收集在西安市儿童医院康复训练中心进行训练的ASD患儿，采用连续入组方法共纳入193例（病例组）。按照11配对病例对照研究要求，2016年3月1日至7月1日收集在西安市城区幼儿园及小学就读的儿童193例为健康对照组。病例组患儿年龄（40.78±14.86）个月，健康对照组儿童年龄（40.61±14.40）个月。2组中男167例，女26例，男女比例为6.421.00。2组由家长填写一般情况问卷、儿童病史问卷、ASD诊断表、孤独症行为评定量表（ABC）、家庭环境量表中文版（FES-CV），病例组由医师填写儿童孤独症评定量表（CARS）。采用Excel软件双人双份录入原始问卷，建立数据库，采用SPSS 17.0统计软件进行分析，并应用条件Logistic回归进行多因素分析。结果 70.8%（137/193例）的ASD患儿在2岁及以前发现异常，54.9%（106/193例）在3岁及以前得到确诊，从发现异常到确诊平均延迟17个月。最初异常主要表现：对呼唤无反应153例（79.3%）、很少与人主动接触141例（73.1%）、沉默不语或较少使用语言137例（71.0%）、避免与他人目光接触或缺少面部表情121例（62.7%），容易被误诊为精神运动发育迟缓及语言发育迟缓。病例组开始独走年龄为8个月～3岁，62.2%（120/193例）的患儿在18月龄及之前学会独走。开始有意识言语的年龄为8个月～4岁4个月，39.4%（76/193例）的患儿在18月龄及之前学会说话。病例组ABC量表总分（56.520±22.140）分，分量表及总分均显著高于健康对照组，差异均有统计学意义（t＝16.845、27.390、16.527、26.320、23.371、32.206，均P〈0.001），ABC量表与临床诊断的阳性符合率为56.5%。病例组CARS量表总分平均（36.4±8.6）分，CARS与临床诊断的阳性符合率为78.8%。2组在父母文化程度、母Objective To explore the early clinical characteristics and influencing factors in children with autism spectrum disorders（ASD）.Methods From January 2005 to December 2014, 193 children with ASD were collec-ted by continuous grouping method from Children′s Rehabilitation Training Center in Xi′an.According to the 11 matched case-control study requirements, and the other 193 children from kindergartens and primary schools in the urban areas of Xi′an were collected as healthy control group from March 1 to July 1, 2016.The age of children in the case group was （40.78±14.86）months and the age of the healthy control group was （40.61±14.40） months.There were 167 boys and 26 girls in 2 groups and the ratio of boys to girls was 6.421.00.The general status questionnaires, medical history questionnaire, diagnostic chart, Autism Behavior Checklist（ABC） and Family Environment Scale of Chinese version（FES-CV） were completed by parents between 2 groups.Childhood Autism Rating Scale（CARS） was completed by doctors in the case group.By using Excel software, the original questionnaires were completed in 2 entries by 2 persons to set up the database.All data were analyzed by SPSS 17.0 statistical software and conditional Logistic regression was used for multivariate analysis.Results Seventy point eight percent（137/193 cases）of children with ASD had been found abnormal under 2 years old or at 2 years old, and 54.9%（106/193 cases）had been diagnosed under 3 years old or at 3 years old.The average delay from the discovery to the diagnosis was 17 months.The initial abnormalities appea-rances were mainly manifested as no response to calling in 153 cases（79.3%）, very little active contact with others in 141 cases（73.1%）, silent or less use of oral language in 137 cases（71%）, avoiding contact with the eyes of others or lack of facial expressions in 121 cases（62.7%）. Their signs were easy to be misdiagnosed as mental retardation and language retardation.Children in the case group b

关 键 词：孤独症谱系障碍 临床特点 危险因素 

分 类 号：R749.94[医药卫生—神经病学与精神病学]