《年龄与发育进程问卷》中文版在高危儿童发育筛查中效度验证

目的 在高危儿童中行中文版《年龄与发育进程问卷》（ASQ-C）的进一步验证。 方法 以Gesell发育量表为效度标准，对儿童发育迟缓门诊就诊的2~60月龄的儿童同时实施Gesell发育量表和ASQ-C评测，分析ASQ-C及其不同领域在不同年龄组及不同筛查界值时的诊断参数。 结果 符合本文纳入标准的高危儿130例进入本文分析，男94例，女36例，年龄（19.9±16.4）个月，早产26例。≥18和＜18个月组分别为52例和78例。ASQ-C量表以2 s为筛查界值，其诊断一致率73％，敏感度72.5％（95%CI：63%~82%），特异度74.3%（95%CI：61%~88%），阳性预测值86.8%（95%CI：79%~94%），阴性预测值53.7%（95%CI：40%~67%）。ASQ-C以1 s为筛查界值，其诊断一致率75％，敏感度92.5%（95%CI：87%~98%），特异度32.4%（95%CI：17%~48%），阳性预测值77.5%（95%CI：70%~85%），阴性预测值632%（95%CI：41%~85%）。≥18个月组儿童中诊断一致率90％~92％、敏感度95.6％~100%；＜18个月组儿童中诊断一致率64％~68％、敏感度59.6%~85.1%。ASQ-C在适应性能区、粗大运动能区、精细动作能区、语言能区和个人社会能区与Gesell发育量表相应领域的诊断一致率68％~80％，敏感度46.6%~85%，特异度64.3%~93.7%，语言能区的敏感度（63.3%~85%）高于精细运动能区（47%~68.2%）。 结论 ASQ-C与北京Gesell发育量表对应领域的一致性好。ASQ-C作为发育筛查量表用于高危儿临床效度虽在可接受范围内，但达不到理想筛查量表的参数水平。对＜18个月的高危儿童，以1 s为界值的敏感度显著提高，可降低漏诊。

The validity of the Chinese version of ASQ in high risk children

Objective ASQ-C is a newly introduced and standardized questionnaire for childrenˊs development in China. The validity of ASQ-C was not fully tested . In this study,the Gesell developmental scale was used as a diagnostic scale to test the validity of the ASQ-C in high risk children. Methods The 130 samples were selected in the outpatient of children development, who were evaluated by both ASQ-C and Gesell development scale. Cutoff points for all ASQ-3 age-versions were calculated in two ways and the samples were divided into 2 groups according to the age. The sensitivity,specificity,positive and negative predictive values were calculated. The subscales of ASQ-C were analyzed according to the corresponding scales of Gesell development scale. Results In generally,the coincidence rate was 0. 73,sensitivity and specificity were 72. 5%(95%CI:63% to 82%)and 74. 3%(95%CI:61% to 88%),the PPV and NPV were 86. 8%(95%CI:79% to 94%)and 53. 7%(95%CI:40% to 67%). Using 1 s as the cutoff,the sensitivity and specificity were 92. 5% and 32. 4%,the PPV and NPV were 77. 5%(95%CI:70% to 85%)and 63. 2%(95%CI:41% to 85%). Sensitivity and specificity values were higher for the older age-cohort than for the younger age-cohort. The sensitivity and specificity of the subscale were 46. 6% to 85% and 64. 3% to 93. 7%. Conclusion The ASQ-C was a developmental screening scale,its validity was within acceptable range,but failed to reach the ideal screening scale level. For less than 18 months of high-risk children,using 1s as the cutoff may significantly improve the sensitivity and reduce missed diagnosis.