摘要
目的探索在妇幼保健体系中实施孤独症谱系障碍(ASD)的早期发现、早期诊断、早期干预的可行性,从而建立ASD早期筛查模式并推广。方法对珠海市初级卫生保健人员进行ASD早期筛查及早期识别专项继续教育培训,以增加初级卫生保健人员对ASD的识别及转诊能力。同时,采用横断面现况调查,2017年7月至2018年6月期间在珠海高新技术产业开发区金鼎社区卫生服务中心、珠海市香洲区人民医院预防保健科健康体检的1.5~3岁儿童2183人(次),应用"筛查-确诊"ASD二级早期筛查模式(指初级卫生保健机构进行一级筛查、专科医院确诊的模式),选择婴幼儿孤独症量表中文简化版(M-CHAT中文简化版)为一级筛查工具,量表筛查阳性者经珠海市妇幼信息系统转诊至珠海市妇幼保健院儿童心理科确诊并进行早期干预。结果于2016、2017、2018年对初级卫生保健人员进行ASD早期筛查专项培训,分别培训335人、118人、189人,参加培训人员对ASD知晓率由培训前的20.0%、42.4%、47.6%分别上升到91.6%、93.2%、93.1%,每一年培训前后初级卫生保健人员对ASD知晓率有明显上升,差异有统计学意义(P<0.01)。同期,ASD儿童诊断年龄由2016年(3.40±1.85)岁下降到2017年的(3.03±1.22)岁及2018年的(2.95±1.02)岁,2016年与2017年、2018年之间的差异有统计学意义(P<0.01)。2017年7月至2018年6月期间,在基层卫生保健机构共计筛查2183人(次),收回有效问卷1904份,有效问卷回收率为87.2%;一级筛查阳性238人,一级筛查阳性率为12.5%;筛查阳性后转诊至专科共计175人,转诊率为73.5%;最终确诊ASD(包括疑似ASD患儿)18人,复筛ASD阳性率为10.3%,筛查总体阳性率为0.95%。结论加强初级卫生保健人员对ASD的识别及转诊能力培训,同时运用M-CHAT中文简化版为一级筛查工具"筛查-确诊"的ASD早期筛查模式,有助于早期发现ASD儿童,降低ASD儿童诊断年龄,是可行的ASD早期筛查管理模式。
Objective To investigate the feasibility of early detection,early diagnosis and early intervention of autism spectrum disorder(ASD)in maternal and child health care system,and to establish and promote ASD early screening mode.Methods The primary health care personnel in the City of Zhuhai were trained for early screening and early identification of ASD.Using the cross-sectional survey,from July 2017 to June 2018,2183 children(times)from 1.5 to 3 years old in a community health service center of Zhuhai and a health checkup in the People′s Hospital of a district were analyzed.The Screening-confirmation ASD secondary screening mode(primary health care institution for primary screening and specialist for diagnosis mode)was applied.The M-CHAT Chinese simplified version was applied as the first-level screening tool.The infants with positive screening results were referred to the Children′s Psychology Department of Zhuhai Maternal and Child Health Hospital for early diagnosis and intervention using Maternal and Child Information System of Zhuhai.Results In 2016,2017 and 2018,special training for early screening of ASD were conducted for 335,118,and 189 primary health care workers was conducted,respectively.The awareness rates of ASD were 20.0%,42.4%and 47.6%before training,and rose to 91.6%,93.2%,and 93.1%,respectively,after training.The awareness rate of ASD among primary health care workers after training was significantly increased(P<0.01).In the same period,the age of diagnosis of ASD in 2016 was(3.40±1.85)years and reduced to(3.03±1.22)years in 2017 and(2.95±1.02)years in 2018,with significantly differences among them(P<0.01).Between July 2017 and June 2018,2183 infants were screened in primary health care institutions,and 1904 valid questionnaires were returned.The effective questionnaire recovery rate was 87.2%.Totally 238 infants were positive for primary screening,with primary screening positive rate of 12.5%;among whom,175 were referred to specialists,with referral rate of 73.5%.The final diagnosis of ASD(including children with suspected ASD)were proved in 18 infants,the re-screening ASD positive rate was 10.3%,and the overall screening positive rate was 0.95%.Conclusion Strengthen the training of primary health care personnel in the identification and referral ability of ASD,using the M-CHAT Chinese simplified version as the first screening tool and screening-diagnosis ASD early screening mode can help early detection of ASD,reducing the age of diagnosis.
作者
陈强
何淑卿
耿秀梅
徐文娟
戚小兵
钟洁琼
陈红
杨丽勇
庄志成
周翔
杨秉娇
Shu-qing;GENG Xiu-mei;XU Wen-juan;QI Xiao-bing;ZHONG Jie-qiong;CHEN Hong;YANG Li-yong;ZHUANG Zhi-cheng;ZHOU Xiang;YANG Bing-jiao(Department of Children's Psychology,Zhuhai Maternal and Child Health Hospital,Zhuhai 519001,Guangdong,China)
出处
《广东医学》
CAS
2020年第2期134-138,共5页
Guangdong Medical Journal
基金
广东省医学科学技术研究基金项目(B2018141)
珠海市医疗卫生科技计划项目(20161027E030040).
