孤独症谱系障碍婴幼儿早期筛查模式的探究

目的 分析Bayley婴幼儿发展量表第Ⅰ版(BSID Ⅰ)联合改良版婴幼儿孤独症筛查量表(M-CHAT-R/F)筛查婴幼儿孤独症谱系障碍(ASD)的效果,为基层儿保系统开展ASD早期筛查提供临床数据依据。方法 采用前瞻性队列研究,选取2019年1—12月期间在义乌市妇幼保健院参与“0~3岁儿童早期发展风险和异常筛查项目”采用BSID Ⅰ评估的6~12月龄婴儿为研究对象。采用2010年卫生部颁布《儿童孤独症诊疗康复指南》中婴儿期孤独症警示指标对6~12月龄阳性患儿进行BSID Ⅰ评估。对认知发展指数(MDI)、运动发展指数(PDI)异常(MDI或PDI <80)的婴儿追踪随访,18月龄进行M-CHAT-R/F评估,后由专科医师进一步根据DSM-5进行ASD确诊。结果 纳入研究3 096例,警示指标阳性患儿535例,BSID Ⅰ发育异常421例,占13.60%。18月龄时进行M-CHAT-R/F评估阳性共38例,初筛总阳性率为9.97%,最终确诊ASD 16例。将BSID Ⅰ MDI<80作为预测因子,其在ASD组与非ASD组筛查中具有统计学意义(χ²=10.28,P＜0.01),BSID Ⅰ对ASD筛查的阳性预测值为0.076,联合M-CHAT-R/F阳性预测值可提高至0.42。结论 BSID Ⅰ联合M-CHAT-R/F可提高对婴幼儿ASD筛查的阳性预测值,建议对婴儿期BSID Ⅰ MDI<80的患儿进行18月龄M-CHAT-R/F筛查,为ASD早期筛查提供新方法。

Exploration of early screening model for infants with autism spectrum disorders

Objective To evaluate the screening efficacy of autism spectrum disorder (ASD) by the Bayley Scales of Infant Development-Ⅰ(BSID Ⅰ) combined with Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT-R/F), in order to provide clinical basis for early ASD screening in primary child care system.Methods Infants aged 6 to 12 months, who participated in Early Developmental Risk and Abnormality Screening Program for 0 - 3 Years Old Children in Yiwu Maternal and Child Health Hospital using BSID Ⅰ evaluation from January to December 2019 were enrolled in this for a prospective cohort study.BSID Ⅰ were conducted in the children with positive autism alert indexin Autism Diagnosis and Rehabilitation Guide issued by the Ministry of Health in 2010.Infants with abnormal mental development index (MDI) and psychomotor development index (PDI) (MDI or PDI<80) were followed up. M-CHAT-R/F assessment was performed at 18 months of age, then further diagnosis of ASD was made based on DSM-5 by a specialist.Results Totally 3 096 cases were included in the study, of whom 535 cases with positive autism alert index and421 cases (13.60%) had abnormal BSID Ⅰ results. At 18 months of age, a total of 38 (9.97%) children were screened positive by M-CHAT-R/F evaluation, and 16 children were finally diagnosed with ASD. When taking BSID Ⅰ MDI<80 as a predictor, its proportion was significantly different between ASD group and non-ASD group (χ²=10.28, P<0.01). The positive predictive value of BSID Ⅰ for ASD screening was 0.076, which increased to 0.42 when combined with M-CHAT-R/F.Conclusions BSID Ⅰ combined with M-CHAT-R/F can improve the positive predictive value of ASD screening in infants. It is suggested that m-CHAT-R /F screening at 18 months of age should be performed in infants with BSID Ⅰ MDI<80, thus to provide a new method for early screening of ASD.