孤独症筛查量表在早期识别孤独症谱系障碍中的临床价值

Value of autism screening checklists in the early identification of autism spectrum disorder

摘要:

目的 探讨孤独症筛查量表早期识别孤独症谱系障碍（ASD）的临床价值。方法 以于重庆医科大学附属儿童医院就诊，并完成ASD筛查及诊断性测试的2 571名儿童为研究对象，最后确诊ASD 2 074例，全面发育迟缓（GDD）261例，发育性语言障碍（DLD）206例，正常发育儿童30例。运用受试者工作特征（ROC）曲线评价改良婴幼儿孤独症筛查量表（M-CHAT）和孤独症行为量表（ABC）筛查ASD的最佳阈值及灵敏度、特异度。结果 M-CHAT量表筛查ASD的灵敏度较高（88.3%），特异度较低（36.0%）；其灵敏度随着年龄的增长而降低，在16~< 48月龄儿童中，其灵敏度大于80%。ABC量表筛查ASD的特异度较高（87.3%），灵敏度较低（27.2%）；运用ROC曲线方法得出其最佳截点值为47.5分。联合M-CHAT和ABC量表筛查ASD，并建立多元线性回归模型，其特异度为85.8%，灵敏度为56.6%。结论 M-CHAT量表筛查ASD灵敏度较高，但特异度较低；在16~< 48月龄儿童中的筛查效果相对较好。ABC量表筛查ASD特异度较高，但灵敏度较低。基于联合M-CHAT和ABC量表筛查ASD的多元线性回归模型法识别ASD的效能较好。

Abstract:

Objective To evaluate the value of autism screening checklists in the early identification of autism spectrum disorder(ASD). Methods A total of 2 571 children who attended the Children’s Hospital of Chongqing Medical University and completed autism screening and diagnostic test were enrolled as subjects, among whom 2 074 were diagnosed with ASD, 261 were diagnosed with global developmental delay(GDD), 206 were diagnosed with developmental language disorder(DLD), and 30 had normal development. The sensitivity, specificity, and optimal threshold value of the Modified Checklist for Autism in Toddlers(M-CHAT) and the Autism Behavior Checklist(ABC) for the early identification of ASD were evaluated by the receiver operating characteristic(ROC) curve. Results The M-CHAT had a high sensitivity of 88.3% but a low specificity of 36.0% for the identification of ASD. Its sensitivity decreased with age, and was maintained above 80% for children aged 16 to <48 months. The ABC had a high specificity of 87.3% but a low sensitivity of 27.2%, with an optimal cut-off value of 47.5 based on the ROC curve analysis. The multivariate linear regression model based on a combination of the M-CHAT and ABC for screening of ASD showed a specificity of 85.8% and a sensitivity of 56.6%. Conclusions The M-CHAT has a high sensitivity and a low specificity in the identification of ASD, with a better effect in children aged 16 to <48 months. The ABC has a high specificity and a low sensitivity. The multiple linear regression model method based on the combined M-CHAT and ABC to screen ASD appears to be effective.