ACE腺样体内镜分级法的信效度验证及其在儿童阻塞性睡眠呼吸暂停中的应用研究OA
Reliability and validity of the endoscopic ACE adenoid grading system and its application in pediatric obstructive sleep apnea
目的 对ACE腺样体内镜分级法(简称ACE分级法)开展信效度验证,并探讨该分级方法在儿童阻塞性睡眠呼吸暂停(OSA)临床评估中的应用价值.方法 连续纳入2022年3月~2023年3月于北京儿童医院就诊的231例患儿,所有患儿均完成鼻咽内镜检查及多导睡眠监测.5名耳鼻咽喉科医师采用ACE分级法独立完成腺样体形态评分;间隔4周实施重复测评.采用Fleiss'Kappa检验评价观察者间信度,Cohen's Kappa检验评价观察者内重测信度;结合临床结局指标开展构念效度分析.以OSA患病与否、OSA严重程度分级分别作为因变量,构建二分类及有序Logistic回归模型,分析ACE各维度与儿童OSA的相关性.结果 ACE分级观察者间一致性中等至良好(A:κ=0.499,C:κ=0.589,E:κ=0.626),观察者内一致性良好至优(κ:0.693~0.964),量表信度可靠.OSA组与非OSA组A、C、E评分及扁桃体肥大比例差异显著(P<0.01),构念效度良好.校正扁桃体分度后,A、C、E评分与OSA发病无独立相关性(P>0.05);A评分(χ²=11.59,P=0.009)、C评分(χ²=6.96,P=0.031)与OSA严重程度显著相关,E评分无明显关联(P=0.907).结论 ACE分级法本土化信效度良好、可重复性强,可标准化评估腺样体形态.A、C维度可有效预判儿童OSA严重程度,适用于患儿病情分层管理,E维度对OSA评估无明显参考价值,临床应用中可适当简化.
OBJECTIVE To validate the reliability and validity of the ACE endoscopic adenoid grading system and to explore its clinical value in the assessment of pediatric obstructive sleep apnea(OSA).METHODS A total of 231 children consecutively admitted to Beijing Children's Hospital from March 2022 to March 2023 were enrolled.All children underwent nasopharyngeal endoscopy and polysomnography.Five otolaryngologists independently graded adenoid morphology using the ACE adenoid grading system;repeated assessments were performed at an interval of 4 weeks.Inter-rater reliability was evaluated using Fleiss'Kappa test,and intra-rater test-retest reliability was evaluated using Cohen's Kappa test.Construct validity was analyzed in conjunction with clinical outcome measures.Binary and ordinal Logistic regression models were constructed with OSA status and OSA severity grading as dependent variables,respectively,to analyze the association between each dimension of the ACE system and pediatric OSA.RESULTS The inter-rater agreement of the ACE grading system was moderate to good(A:κ=0.499,C:κ=0.589,E:κ=0.626),and the intra-rater agreement was good to excellent(κ:0.693-0.964),indicating reliable psychometric properties.Significant differences in A,C,and E scores and the proportion of tonsillar hypertrophy were observed between the OSA and non-OSA groups(all P<0.01),demonstrating good construct validity.After adjusting for tonsillar grading,the A,C,and E scores showed no independent association with OSA occurrence(all P>0.05).However,the A score(χ²=11.59,P=0.009)and C score(χ²=6.96,P=0.031)were significantly associated with OSA severity,whereas the E score showed no significant association(P=0.907).CONCLUSION The ACE endoscopic adenoid grading system demonstrates good reliability,validity,and reproducibility in the Chinese pediatric population,enabling standardized assessment of adenoid morphology.The A and C dimensions can effectively predict OSA severity in children and are suitable for stratified disease management.The E dimension offers limited reference value for OSA assessment and may be appropriately simplified in clinical practice.
李晓丹;王生才;龙婷;张丰珍;李宏彬;刘雨薇;刘笑歌;王桂香;王华;赵靖
国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045哈尔滨医科大学,黑龙江 哈尔滨 150081国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045国家儿童医学中心,首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京 100045
儿童睡眠呼吸暂停,阻塞性预测腺样体肥大ACE分级法信度及效度
ChildSleep Apnea,ObstructiveForecastingadenoid hypertrophyACE grading systemreliability and validity
《中国耳鼻咽喉头颈外科》 2026 (7)
386-391,6
北京市高层次创新创业人才"登峰计划项目"(G20251057)
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