目的 研究全身运动(general movements assessment,GMs)质量评估和0~1岁20项神经运动检查法(20项检查法)对高危儿粗大运动发育结局和脑性瘫痪预测效度的比较。方法 按照纳入标准,选择30名高危儿为研究对象,在不安运动阶段(足月后9周龄~5月龄)进行GMs评估以及20项检查法各1次。随访至纠正年龄1周岁以后根据临床表现以及采用Peabody运动发育量表2(Peabody Developmental Motor Scale 2,PDMS-2)评估粗大运动发育结局以及是否为脑性瘫痪。计算两种方法的敏感度、特异度、阳性预测值、阴性预测值以及Kappa值进行比较。结果 纳入的30例研究对象中,脑性瘫痪3例(10%)例,粗大运动发育落后5例(16.7%)(包括3例脑性瘫痪),25例(83.3%)正常。GMs对粗大运动发育落后的预测效度:敏感度80.0%,特异度96.0%,阳性预测值80.0%,阴性预测值96.0%;20项检查法对粗大运动发育落后的预测效度:敏感度100.0%,特异度92.0%,阳性预测值71.4%,阴性预测值100.0%。GMs对脑性瘫痪的预测效度:敏感度100.0%,特异度92.6%,阳性预测值60.0%,阴性预测值100.0%;20项检查法对脑性瘫痪的预测效度:敏感度100.0%,特异度85.2%,阳性预测值42.9%,阴性预测值100.0%。两种方法的Kappa值=0.59。结论 在足月后9周龄~5月龄阶段,两种方法对粗大运动发育结局的预测各有优势,GMs对脑瘫预测更优,两种评估方法有中等程度的一致性。

Objective To compare qualitative general movements assessment (GMs assessment) and 20 items neurological assessment from birth to 1 year (20 items assessment) for gross motor outcome and cerebral palsy in high risk infants.Methods According to the inclusion criteria,30 infants were confirmed as the participants.GMs and 20 items were assessed one times during fidgety movements period (correct age from 9 weeks to 5 months).Gross motor outcome and cerebral palsy were determined by clinic performs and Peabody Developmental Motor Scale at least after one year old.Sensitivity,specificity,positive predictive value,negative predictive value and Kappa index were calculated.Results 3（10%） infants were cerebral palsy,5 (16.7%) infants were gross motor retardation,25(83.3%) infants were normal gross motor development.Predictive validity of GMs for gross motor retardation was as follows：sensitivity 80.0%,specificity 96.0%,positive predictive value 80.0%,negative predictive value 96.0%；Predictive validity of 20 Items for gross motor retardation was as follows：sensitivity 100.0%,specificity 92.6%,positive predictive value 60.0%,negative predictive value 100.0%；Predictive validity of GMs for cerebral palsy was as follows：sensitivity 100.0%,specificity 92.6%,positive predictive value 60.0%,negative predictive value 100.0%；Predictive validity of 20 Items for cerebral palsy was as follows：sensitivity 100.0%,specificity 85.2%,positive predictive value 42.9%,negative predictive value 100.0%；Kappa=0.59.Conclusions During fidgety movements period，predictive validity for gross motor retardation of two methods have advantages,GMs is better at predicting cerebral palsy.Two methods with moderate consistency,have comprehensive application in high risk infants follow-up work.