三甲医院和社区孤独症谱系障碍早期筛查的结果比较  

Comparison of the early screening results for autism spectrum disorder in GradeⅢ level A hospitals and community health services

作　　者：郭翠华[1] 罗美芳 王旭祥[1] 戴美霞[1] 静进[1] GUO Cui-hua ,LUO Mei- fang ,WANG Xu-xiang, DAI Mei-xia , JING Jin(Department of Maternal and Child Health ,School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, Chin)

机构地区：[1]中山大学公共卫生学院妇幼卫生系,广东广州510080

出　　处：《中国儿童保健杂志》2018年第4期372-375,共4页Chinese Journal of Child Health Care

基　　金：国家自然科学基金(81573169)

摘　　要：目的对三甲医院和社区常规保健幼儿进行孤独症谱系障碍筛查,探讨两者在接诊流程及结局上的差异,为今后开展筛查工作提供线索。方法 7 381名16~30月龄的儿童参与了孤独症谱系障碍筛查,其中三甲医院4 930人,社区2 451人。采用1∶1倾向评分匹配方法得到一般信息均衡的2 451对儿童,比较三甲医院和社区的筛查及诊断结果。结果匹配后,三甲医院的初筛阳性率(17.7%)及后续访谈阳性率(42.5%)均高于社区(8.2%和2.8%)(P<0.001);诊断失访率(11.7%)显著低于社区(47.0%)(P<0.001)。两组样本的后续访谈失访率接近(49.2%vs 47.0%)(P=0.611)。结论三甲医院和社区的筛查假阳性率均偏高,仍需提高应答准确率及重视后续访谈。相比三甲医院,社区失访儿童更容易面临延误诊疗的风险,建立主动监测、转诊及随访体系有助于促进基层医疗机构的早期筛查和诊断。Objective To compare the screening results for autism spectrum disorder （ASD） between Grade Ⅲ level A hospitals and community health services,and to provide clues for future screening work. Methods A total of 7 381 tod- dlers aged 16-30 months were involved in the ASD screening,including 4 930 toddlers from Grade Ⅲ level A hospitals and 2 451 from communities. By using propensity score matching （PSM） method,2 451 pairs of toddlers with comparable basic information were used to compare the screening results between Grade Ⅲ level A hospitals and communities. Results The positive rate of Grade Ⅲ level A hospitals （17.7%） was higher than that of the communities （8.2%）. The positive rate of follow-up interview（42.5 %） was also higher than that of the communities （2.8%）（P〈0.001）. But the lost rate of diag- nosis （11.7%） was lower than that in the communities （47.0%） （P〈0. 001）. The lost rates of follow-up interview in two kinds of samples were close（49.2% vs 47.0%, P = 0.611）. Conclusions The false positive rate in both Grade Ⅲ level A hos- pitals and communities is so high that the accuracy should be improved and follow-up interview should be taken seriously. Those failed to be followed up in communities are more likely to increase the risk of delayed diagnosis and treatment. An active monitoring, referral and follow-up system may help to improve early screening and diagnosis in primary health care services.

关 键 词：孤独症谱系障碍 早期筛查 三甲医院 社区 

分 类 号：R179[医药卫生—妇幼卫生保健]