孤独症谱系障碍初筛阳性患儿康复训练后再评估的诊断研究  

The diagnosis study of post-rehabilitation reevaluation of children with positive initial screening for autism spectrum disorders

作　　者：李沙沙 赵金霞 肖爽 朱丹 王翠 钱静[1] LI Shasha;ZHAO Jinxia;XIAO Shuang;ZHU Dan;WANG Cui;QIAN Jing(Department of Child Healthcare,Liaocheng People's Hospital,Shandong Liaocheng 252000,China)

机构地区：[1]聊城市人民医院儿童保健科,山东聊城252000

出　　处：《中国妇幼健康研究》2024年第2期31-37,共7页Chinese Journal of Woman and Child Health Research

基　　金：全民健康科技发展专项基金项目(Z2020LSD021);聊城市重点研发计划政策引导类项目(2022YDSF34)。

摘　　要：目的探讨孤独症谱系障碍(ASD)初筛阳性患儿康复训练后再评估的诊断情况及相关因素分析。方法采用回顾性研究方法,选取2019年8月至2022年8月在聊城市人民医院儿童保健科行ASD初筛阳性患儿97例,将其分为≤24个月(12例)、>24~≤36个月(47例)、>36~≤72个月(38例)3个年龄段,再依据《美国精神障碍诊断统计手册第5版》(DSM-5)诊断标准将其分为ASD组(73例)与非ASD组(24例)。收集患儿初诊时儿童孤独症评定量表(CARS)或修订的幼儿孤独症筛查量表-后续修订版(M-CHAT-R/F)量表和盖泽尔发育诊断(Gesell)量表各能区得分,分析ASD初筛阳性患儿康复训练后再评估诊断情况及相关因素。结果有75.3%的ASD初筛阳性患儿康复训练后再评估符合ASD诊断,其中男患儿占71.8%,女患儿占100.0%。ASD初筛阳性患儿康复训练后再评估,ASD诊断符合率随年龄段增长呈依次上升趋势(χ2=10.032,P=0.002)。康复训练后再评估,ASD组患儿的Gesell量表中适应性、大运动、精细动作、语言、个人-社交能区得分均明显低于非ASD组,差异均有统计学意义(t值分别为-3.268、-1.970、-2.472、-3.205、-3.570,P<0.05)。康复训练后再评估,ASD诊断符合率与适应性(r=0.325)、大运动(r=0.229)、精细动作(r=0.241)、语言(r=0.286)、个人-社交(r=0.356)能区发育落后程度均呈正相关(P<0.05)。ASD组≤24个月患儿的M-CHAT-R/F量表得分明显低于非ASD组(t=-4.950,P<0.05),ASD组>24~≤36个月患儿的CARS量表和M-CHAT-R/F量表得分均明显高于非ASD组(t值分别为2.166、2.151,P<0.05),ASD组>36~≤72个月患儿的CARS量表得分也明显高于非ASD组(t=2.695,P<0.05)。对于>24个月的患儿,高CARS量表得分是康复训练后再评估诊断为ASD的危险因素(OR=1.367,95%CI:1.133~1.776,P<0.05),对于>24~≤36个月的患儿,高M-CHAT-R/F量表得分是康复训练后再评估诊断为ASD的危险因素(OR=1.623,95%CI:1.122~2.765,P<0.05)。结论ASD初筛阳性患儿康复�Objective To explore the diagnosis and analysis of factors associated with post-rehabilitation reevaluation of children with positive initial screening for autism spectrum disorder(ASD).Methods A retrospective research analysis was used,97 cases children with positive initial screening for ASD were selected from August 2019 to August 2022 in the Department of Child Healthcare of Liaocheng People's Hospital,which were categorized into three age groups:≤24 months(12 cases),>24-≤36 months(47 cases),and>36-≤72 months(38 cases),and then,based on the diagnostic and statistical manual of mental disorders,fifth edition(DSM-5)of the United States,the children were divided into ASD group(73 cases)and non-ASD group(24 cases)according to the diagnostic criteria of the DSM-5.The Childhood Autism Rating Scale(CARS)or the Modified Childhood Autism Screening Scale-Revised/Further Revised(M-CHAT-R/F)scale and the Gesell Developmental Diagnostic Scale scores were collected at the time of the initial diagnosis of the children to analyze the diagnosis of the children with positive initial screening for ASD and the related factors after the reassessment of the diagnosis after the rehabilitation training.Results 75.3%children diagnosed as ASD after rehabilitation and the rate was 71.8%in male and 100%in female children respectively.In children with positive initial screening for ASD who were reevaluated after rehabilitation training,the compliance rate of ASD diagnosis increased sequentially with the age group(χ2=10.032,P=0.002).Reevaluated after rehabilitation training,children in the ASD group had significantly lower scores on the Gesell scale in adaptive,gross motor,fine motor,language,and personal-social competence areas than those in the non-ASD group,and the differences were all statistically significant(t=-3.268,-1.970,-2.472,-3.205 and-3.570,respectively,P<0.05).Reassessed after rehabilitation,the ASD diagnostic compliance rate was positively correlated with the degree of developmental lag in adaptive(r=0.325),gross-mot

关 键 词：孤独症谱系障碍 筛查阳性 康复训练 诊断 

分 类 号：R174[医药卫生—妇幼卫生保健]