重症肌无力严重程度新量表的形成与信度效度评价  

Development and evaluation of reliability and validity of new scales measuring severity of myastheniagravis

作　　者：李海峰[1] 王琳[2] 高翔[3] 夏梦 张栩[2] 杨欢[5] 周红雨[6] 谢琰臣[7] 邱伟[8] Li Haifeng;Wang Lin;Gao Xiang;Xia Meng;Zhang Xu;Yang Huan;Zhou Hongyu;Xie Yanchen;Qiu Wei(Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China)

机构地区：[1]山东大学齐鲁医院神经内科,济南250012 [2]青岛大学附属医院康复科 [3]青岛大学附属医院神经内科 [4]中国海洋大学校医院 [5]中南大学湘雅医院神经内科 [6]四川大学华西医院神经内科 [7]首都医科大学附属北京友谊医院神经内科 [8]中山大学第三医院神经内科

出　　处：《中华神经科杂志》2018年第6期430-437,共8页Chinese Journal of Neurology

基　　金：国家自然科学基金面上项目(81070963,81771362);山东省自然科学基金面上项目(ZR2010HM019);青岛市民生科技计划项目(17-3-3-26-nsh);山东大学齐鲁医院(青岛)研究基金项目(QDKY20152D01)

摘　　要：目的研制适合我国临床使用的重症肌无力（MG）严重程度量表.方法使用60例MG患者的测评数据,在Delphi法结合前期评价形成有10个条目的初始量表基础上,用条目的观察者间信度、重测信度、条目对内部一致性和结构效度的贡献筛选条目编制新量表.对形成的新量表,评价条目的观察者间信度和重测信度以及量表的内部一致性、观察者间信度和重测信度、结构效度和与现有量表的相关性.用患者能自测的项目形成自评量表,在57例全身型MG患者进行评价.结果因观察者间信度和重测信度差删除1个条目（睑裂）,其他9个条目构成完整的新量表,涉及MG累及的全部6个肌群.新量表各条目的观察者间信度合理到很好（K=0.43-0.80,P〈0.01）,重测信度合理到很好（K=0.41-1.00,P〈0.01）;量表的内部一致性较好（Cronbachɑ=0.63）,观察者间信度[组内相关系数（ICC）=0.88,P〈0.01]和重测信度（ICC=0.86,P〈0.01）均很好;有4项公因子,累积方差贡献率68.46％,结构效度良好;与MG复合评分（MGC）、MG绝对和相对评分法（ARS-MG）和MG定量评分（QMGs）高度相关（r=0.87-0.90,P〈0.01）,与MG日常生活量表（MG-ADL）中度相关（r=0.68,P〈0.01）.删除眼肌和面肌条目形成自评量表,包括6个条目,涉及球部肌、四肢肌、颈肌和呼吸肌4个肌群.自评量表的内部一致性（Cronbachɑ=0.69）、观察者间信度（ICC=0.90,P〈0.01）和重测信度（ICC=0.90,P〈0.01）均优于完整量表;有2项公因子,累积方差贡献率64.24％,结构效度良好;与完整量表、MGC和ARS-MG高度相关（r=0.74-0.86,P〈0.01）,与QMGs和MG-ADL中度相关（r=0.55-0.68,P〈0.01）.结论在Delphi法形成的初始量表基础上优化条目形成完整的新量表和自评量表.完整的新量表和自评量表均有良好的信度和效度,能可靠有效地测量MG的严重程度.Objective To develop new scales on the severity of myasthenia gravis （ MG） which are suitable for clinical practice in China .Methods A final version of new comprehensive scale was developed by item optimization from a preliminary scale established by combination of Delphi method and previous evaluation of items from source scales .With the original quantitative data from 60 MG patients, items were selected on the basis of interobserver and test-retest reliability of items , the contributions of items on internal consistency and construct validity of the preliminary scale .Evaluation of this final scale includes internal consistency, interobserver and test-retest reliability, construct validity and correlation with currently used scales.A self-rating version was simplified from the final scale by including items that can be measured by patients, which was then evaluated in 57 generalized MG patients.Results One item （ palpebral fissure ） was deleted from the preliminary scale due to poor interobserver and test-retest reliability.The remaining nine items constituted the final comprehensive scale which covered six commonly involved muscle groups in MG.All items in the comprehensive scale had fair to excellent interobserver reliability （ K=0.43-0.80, P〈0.01） and fair to excellent test-retest reliability （ K =0.41 -1.00, P〈0.01） .The comprehensive scale had acceptable internal consistency （Cronbach ɑ=0.63）, excellent interobserver reliability （intraclass correlation coefficient （ICC） =0.88, P〈0.01） and test-retest reliability （ICC=0.86, P〈0.01）.The comprehensive scale had four common factors and good construct validity （ cumulative dedication rate 68.46%）.There was high correlation between the comprehensive scale and Myasthenia Gravis Composite （ MGC ） , Absolute and Relative Score of MG （ ARS-MG ） and Quantitative Myasthenia Gravis score （QMGs） （ r=0.87 -0.90, P〈0.01）, and moderate correlation between the comprehensive scale and Myasthenia Gravis Activit

关 键 词：重症肌无力 严重程度 量表 信度 效度 

分 类 号：R746.1[医药卫生—神经病学与精神病学]