摘要：

目的: 评估加拿大老龄化纵向研究癫痫筛查问卷（CLSA-EA，中文版）的信度、效度以及识别国人癫痫的准确性。方法: 纳入2022年8-10月四川省成都市城乡社区受试者以及四川大学华西医院神经内科门诊就诊患者共384例，采用CLSA-EA问卷（中文版）进行调查，并根据2014版国际抗癫痫联盟癫痫诊断标准进行癫痫诊断，采用Kappa系数评估重测信度，Cronbach's α系数评估内部一致性，KMO检验和Bartlett球形检验后再行验证性因子分析评估结构效度，混淆矩阵法计算准确度、灵敏度、特异度、阳性预测值、阴性预测值和诊断一致性。结果: 最终获得有效问卷348份，包括癫痫组190例（54.60%）和非癫痫组158例（45.40%），其中244例为重测受试者，包括癫痫组123例（50.41%）和非癫痫组121例（49.59%）。重测信度分析显示，癫痫组CLSA-EA问卷（中文版）条目Q3a、Q3bⅲ、Q3bⅳ、Q4a、Q4b的一致性中等（0.400 ≤ κ＜0.750，均P=0.000），条目Q1、Q2、Q3bⅰ、Q3bⅱ、Q3bⅴ、Q3bⅵ、Q3bⅶ的一致性较差（0.000 ≤ κ＜0.400，均P＜0.05）；非癫痫组条目Q2、Q3a、Q3bⅰ、Q4a、Q4b的一致性中等（均P=0.000），条目Q3bⅴ、Q3bⅵ的一致性较差（均P=0.000），条目Q3bⅱ、Q3bⅲ、Q3bⅳ不存在一致性（均P＞0.05）。内部一致性评价显示，癫痫组CLSA-EA问卷（中文版）所有条目及所有条目总和的内部一致性较差（Cronbach's α系数＜0.700）；非癫痫组条目Q4a、Q4b的内部一致性较差，其余条目及所有条目总和的内部一致性可接受（Cronbach's α系数为0.700~0.800）。结构效度分析显示，4项公因子的累计方差贡献率仅43%，条目Q1、Q3a未合并入因子。混淆矩阵法计算CLSA-EA2癫痫确定算法筛查癫痫的准确度、灵敏度、特异度、阳性预测值、阴性预测值和一致性均较高（均＞0.900）。结论: CLSA-EA问卷（中文版）具有极高的敏感性和特异性，对癫痫的初步筛查具有一定指导作用，但其在国内的适用性、信度和效度尚待进一步考量。

关键词: 癫痫, 调查和问卷, 流行病学, 中国

Abstract:

Objective: To evaluate the reliability, validity and diagnostic accuracy of the Canadian Longitudinal Study on Aging Epilepsy Algorithm (CLSA - EA) questionnaire (Chinese version) in screening Chinese adult epilepsy. Methods: From August to October 2022, a total of 384 subjects and patients were included, who were respectively screened from urban and rural communities in Chengdu, Sichuan, and Department of Neurology of West China Hospital, Sichuan University. The CLSA - EA questionnaire (Chinese version) was used for the survey. Epilepsy was diagnosed according to 2014 International League Against Epilepsy (ILAE) criteria. Kappa coefficient and Cronbach's α coefficient were used to evaluate test- retest reliability and internal consistency, respectively. Construct validity was used to test validity. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic consistency κ value were calculated by confusion matrix method to evaluate the effect of screening. Results: Finally, 348 questionnaires were obtained, including 190 epileptic cases (54.60%) and 158 non-epileptic cases (45.40%), of which 244 were retested subjects, including 123 epileptic cases (50.41%) and 121 non-epileptic cases (49.59%). Retest reliability analysis in epileptic cases showed that the consistency of items Q3a, Q3b ⅲ, Q3b ⅳ, Q4a and Q4b in CLSA - EA questionnaire (Chinese version) had moderate consistency (0.400 ≤ κ < 0.750; P = 0.000, for all). Items Q1, Q2, Q3bⅰ, Q3bⅱ, Q3bⅴ, Q3bⅵ and Q3bⅶ had poor consistency (0.000 ≤ κ < 0.400;P < 0.05, for all). In non-epileptic cases, the consistencies of items Q2, Q3a, Q3bⅰ, Q4a and Q4b were moderate (P = 0.000, for all), Q3bⅴ and Q3bⅵ were poor (P = 0.000, for all), and no consistencies of Q3b ⅱ, Q3b ⅲ and Q3b ⅳ were found (P > 0.05, for all). The internal consistency evaluation in epileptic cases showed that the internal consistency of all items and the sum of all items in the CLSA -EA questionnaire (Chinese version) were poor (Cronbach's α coefficient < 0.700). The internal consistency of items Q4a and Q4b for non-epileptic patients was also poor, but other items and the sum of all items were acceptable (Cronbach's α coefficient 0.700-0.800). The structural validity analysis showed that the cumulative variance contribution rate of the four factors was only 43%, and items Q1 and Q3a were not incorporated into the factors. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and consistency of CLSA - EA2 epilepsy determination algorithm were higher (> 0.900, for all). Conclusions: The CLSA - EA questionnaire (Chinese version) has high sensitivity and specificity, which can guide the preliminary screening of epilepsy in China. However, the applicability, reliability and validity still need to be further considered.

Key words: Epilepsy, Surveys and questionnaires, Epidemiology, China