孤独症筛查量表M-CHAT与CHAT-23的临床应用研究

目的：分析并比较M-CHAT与CHAT-23量表在临床的适用性,以期为了解孤独症患儿早期特异性临床表现提供依据。方法：选取350例18～36月龄来我院发育儿科就诊的儿童，其中284例在筛查前未诊断为孤独症的儿童作为筛查对象；68例（包括从284名筛查对象中诊断为孤独症患儿2例）诊断为孤独症的患儿为孤独症组；除外284例筛查对象中6例被诊断为孤独症、精神发育迟滞和脑瘫的患儿，余278例儿童为对照组。采用M-CHAT与CHAT-23量表对筛查对象进行孤独症筛查；比较孤独症组与对照组筛查量表各项目阳性率差异；分析并比较M-CHAT和CHAT-23的评价指标，衡量不同判定标准筛查的效果。结果：孤独症患儿量表阳性率最高的项目为第9项；除第16项外孤独症组与对照组量表各项目阳性率差异均有统计学意义（P0.05）。结论：CHAT-23特异度较M-CHAT高,同时成本低、易填写、耗时短、结果易判定，更适合临床筛查孤独症。

Clinical application of M-CHAT and CHAT-23 for autism screening

Objective To analyze and compare Modified Checklist for Autism in Toddlers(M-CHAT) and Checklist for Autism in Toddlers-23(CHAT-23) in terms of clinical applicability,and to provide a basis for the understanding of early specific clinical manifestations of children with autism.Methods A total of 350 children aged 18-36 months who visited the Department of Developmental Pediatrics of Shengjing Hospital of China Medical University were enrolled as subjects.Of the 350 children,284 who had not been previously diagnosed with autism were screened according to the two checklists.Sixty-eight confirmed cases of autism(including two of the 284 screening subjects diagnosed with autism) were assigned to the autism group,and 278 of the 284 screening subjects(except six children diagnosed with autism,mental retardation or cerebral palsy) were assigned to the control group.The two groups were compared with respect to the positive rate for each item in the checklists.The efficacy of the M-CHAT and CHAT-23 assessment criteria was evaluated by comparative analysis.Results The autism group showed the highest positive rate for Item 9.There were significant differences between the two groups in terms of the positive rates for all items except Item 16(P<0.05).When the assessment criterion was that autism was confirmed if there were positive results for at least 3 of a total of 23 items,M-CHAT showed the lowest rate of missed diagnosis(0%);when the assessment criterion was that autism was confirmed if there were positive results for at least 6 of a total of 23 items,CHAT-23 showed the lowest rate of misdiagnosis(1.77%).The specificity of M-CHAT is lower than that of CHAT-23(P<0.05).There was no significant difference in sensitivity between the two checklists(P>0.05).Conclusions CHAT-23 is more suitable than M-CHAT for clinical autism screening due to higher specificity,as well as having the advantages of low cost,easy completion,high efficiency and easy result judgment.