目的 检验婴儿孤独症观察量表中文版(AOSI)临床应用的灵敏度与特异度,评价其临床应用效果.方法 随机抽取1岁时曾在清远市妇幼保健院行AOSI评估,于2～3岁时诊断为孤独症谱系障碍(ASD)的48例患儿为ASD组,诊断为正常发展的46例幼儿作为对照组.比较两组患儿的18个条目得分和总分,采用受试者操作特征(ROC)曲线计算AOSI的特异度、灵敏度、阳性预测值与阴性预测值,并判断AOSI的最佳诊断(阳性)分界值;分析AOSI评估结果与《精神障碍诊断与统计手册(第5版)》(DSM-5)中ASD诊断标准的一致性.结果 两组研究对象性别、年龄比较差异无统计学意义(P＞0.05).ASD组各条目得分和总分均高于对照组,且差异具有统计学意义(P＜0.01).AOSI的曲线下面积(AUC)为1.00(P＜0.01),95%置信区间为(1.00,1.00).不同阳性分界线的灵敏度、特异度、阳性预测值、阴性预测值及一致性相比较,当约登指数等于1.00时AOSI的最佳诊断(阳性截断值)界线为9分时,其上述值均为1.00.AOSI评估结果与DSM-5中ASD的诊断标准完全相一致(Kappa=1,P＜0.01).结论 AOSI应用于评估1岁的婴儿,当取9分为诊断界值时,具有高度的灵敏度与特异度,能较好地预测该婴儿在2～3岁时是否患ASD;AOSI是婴儿期ASD筛查的重要工具,其评估结果可作为ASD高危儿早期干预的证据和ASD的辅助诊断工具,适合于临床推广应用.
Objective To test the sensitivity and specificity of the Chinese version of the Autism Observation Scale for Infants(AOSI)in clinical application and evaluate its clinical application effect.Methods Forty-eight children with autism spectrum disorder(ASD)diagnosed at the age of 2 to 3 years who had undergone AOSI evaluation in Qingyuan Maternal and Child Health Hospital at the age of 1 year(2021)were randomly selected as the ASD group,and 46 children with normal development were randomly selected as the control group.The scores of 18 items and total scores of the two groups of subjects were compared.The specificity,sensitivity,positive predictive value and negative predictive value of AOSI were calculated using the receiver operating characteristic curve(ROC),and the best diagnostic(positive)cut-off value of AOSI was confirmed.The consistency of AOSI evaluation results with the ASD diagnostic criteria in DSM-5 were compared.Results There was no statistically significant difference in genders or age between two groups(P＞0.05).The scores of each item and total scores in the ASD group were significantly higher than those in the control group,and the difference was statistically significant(P＜0.01).The area under the curve of AOSI(AUC=1.00,P＜0.01)had a 95%confidence interval of(1.00,1.00).Comparing the sensitivity,specificity,positive predictive value,negative predictive value and consistency of different positive boundary points,when the Youden index was equal to 1.00,the optimal diagnostic(positive cut-off value)boundary for AOSI was 9 points,and all of the above values were 1.00.The AOSI evaluation results were completely consistent with the diagnostic criteria for ASD in DSM-5(Kappa=1,P＜0.01).Conclusions AOSI has high sensitivity and specificity when it is used to evaluate the 1-year-old infant.When"9 points"is taken as the diagnostic threshold,it can better predict whether the infant has ASD at the age of 2～3 years.AOSI is an important tool for screening ASD in infancy.Its evaluation results can be used as evidence for early intervention of high-risk infants with ASD and as a assisting tool to diagnosis ASD,which is suitable for clinical application.
彭琼;凡伟;黄肖霞;李秋婵;胡卓坚;郭碧华;温慧玲;吴文华
清远市妇幼保健院儿童群体保健科(广东清远 511510)清远市妇幼保健院儿童康复科(广东清远 511510)
婴儿;婴儿孤独症观察量表;评估
infant;the Autism Observation Scale for Infant;assessment
《广州医药》 2024 (004)
360-364 / 5
2022年广东省医学科研基金(A2022119);广东省清远市科技计划项目(221025227687333)
10.3969/j.issn.1000-8535.2024.04.004
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