广州市幼儿园儿童孤独症谱系障碍患病率和相关因素

摘要

Objective: To investigate the epidemic characteristics and related factors of autism spectrum disorders (ASDs) in preschool children of Guangzhou mainstream kindergartens. Methods: In this cross-sectional study, 7500 children aged 2 -6 years were selected from 21 kindergartens of 6 regions in Guangzhou City by multistage sampling method, who were preliminarily screened with the Clancy Autism Behavior Rating Scale( CABRS),children growth and development questionnaire and teacher nomination strategy. The children were observed, evaluated, and diagnosed to get the prevalence and related factors. Results: ( 1 ) The prevalence of ASDs in preschool children in Guangzhou mainstream kindergartens was 75.4/10000 (95％ CI 53.8/10 000 -97.0/10000), and the rates were 29. 5/10000 (95％ CI 16. 1/10000 -43.1/10000) for autism, with the proportion of 16. 7％ for high functioning autism (HFA), 41.0/10000 (95％ CI 25.0/10 000 - 57. 0/10 000) for Asperger syndrome (AS), 4. 9/10000 (95 ％ CI 0/10000 - 10. 6/10000) for pervasive developmental disorder-not otherwise specified (including atypical autism). The sex ratio of male to female was 6. 6: 1. (2) The teacher nomination strategy was used to preliminarily screen ASDs, and the sensitivity was 95.6％, specificity was 91.1％, Youden＇ s index was 0. 867. (3)The proportion of higher maternal (25 - 29 years and 30 - 34 years) and paternal age (30 - 34 years and ≥ 35 years), higher maternal education ( bachelor and above) and maternal emotional instability during the pregnant time in ASDs group were higher than those in the normal group (P ＜ 0. 05), and logistic analysis showed that male children, higher paternal age and maternal emotional instability were the risk factors to ASDs in children. Conclusion:The prevalence of autism spectrum disorders in preschool children in Guangzhou mainstream kindergartens is similar to that of foreign reports. The teacher nomination strategy shows good objectivity, high accuracy and high efficiency in screening stage, and could be used widely.%目的:了解广州市公立幼儿园接受主流教育的学龄前儿童孤独症谱系障碍(ASDs)的流行病学特征及其相关因素.方法:本研究为横断面研究.采用多阶段抽样,抽取广州市5区1市21所公立幼儿园2～6岁儿童7500人,使用克氏孤独症行为量表(CABRS)、儿童生长发育问卷和教师提名策略相结合的方法进行ASDs儿童的初筛,继而对可疑者进行现场观察、评估和诊断,统计和分析ASDs的患病情况及其相关因素.结果:(1)本样本ASDs的患病率75.4/10 000(95%CI 53.8/10 000～97.0/10 000),其中孤独症29.5/10 000(95%CI 16.1/10 000～43.1/10 000),高功能孤独症占16.7%,Asperger综合征为41.0/10 000(95%CI 25.0/10 000～57.0/10 000),其他未加标明的广泛性发育障碍(包括非典型孤独症)为4.9/10 000(95%CI 0/10 000～10.6/10 000),男女比例为6.6:1;(2)教师提名策略对ASDs儿童初步筛查的灵敏度为95.6%,特异度为91.1%,Youden指数为0.867;(3)ASDs组父亲生育年龄在30～34岁以及35岁以上、母亲生育年龄在25～29岁和30～34岁、母亲受教育程度在本科及研究生以上以及母孕期情绪波动所占比例较非ASDs组大(P<0.05),进一步进行logistic回归分析示男性儿童、父亲年龄≥35岁和母孕期情绪波动为ASDs的危险因素.结论:广州市幼儿园接受主流教育的学龄前儿童ASDs患病率与国外报道相当,教师提名策略显示出客观性强、准确度高和效率高等优点,可推广使用,分析出的相关因素可以为孕期保健和教育工作提供针对性的建议.