快速抗原检测对A族链球菌急性咽峡炎的临床诊断价值

THE CLINICAL DIAGNOSTIC VALUE OF RAPID ANTIGEN DETECTION TEST FOR GROUP A STREPTOCOCCAL PHARYNGITIS

目的评价RADT在GAS急性咽部感染诊断中的临床应用价值。方法记录126例疑似猩红热患者的临床表现,并进行评分。使用QuickVue StrepA快速抗原诊断检测盒对所有患者进行检测,并同时进行细菌培养,记录结果。对确诊患者正规使用静脉抗生素治疗1天后,再次进行评分和RADT检测。结果疑似猩红热患者的检测结果中,以细菌培养为金标准,RADT检测的灵敏度为92.5%,特异度为93.5%,一致性检验统计量Kappa=0.848,具有显著统计学意义(P=0.000)。随着患者临床评分的升高,RADT灵敏度由81.8%逐步增加到100%。临床评分与RADT灵敏度具有显著线性相关关系,相关系数r=0.962(P=0.009)。确诊患者使用静脉抗生素治疗1天后再次进行检测,RADT灵敏度明显降低为30.0%。且相同临床评分组治疗前后比较,RADT灵敏度也显著降低(P<0.01)。结论 RADT诊断GAS咽部感染的正确性较高,具有简单、快捷的优势,但对于症状较轻或使用过抗生素治疗患者的诊断效能有所下降。

Objective：To estimate the diagnostic value of RADT in acute GAS pharyngitis.Methods：The clinical manifestations of 126 patients with suspect scarlet fever were recorded and scored.All the patients were detected by the QuickVue dipstick strep A test and bacterial culture.One day after regular antibiotics treatment,the patients diagnosed were scored and detected again.Results：In the patients with suspect scarlet fever,taking bacterial culture as gold standard,the sensitivity and specificity of RADT were 92.5% and 93.5%,Kappa=0.848（P = 0.000）.As the clinical scores increased,there were stepwise increases in RADT sensitivity（from 81.8% to 100%）,and the linear regression shows that they were highly correlated,r=0.962（P=0.009）.One day after venous antibiotic treatment,the sensitivity of RADT decreased to 30.0%.In each group divided by scores,the sensitivity also significantly decreased（P 0.01）.Conclusion：The accuracy of RADT for diagnosing GAS pharyngitis is high,the predominance is simple and fast,but for the patients who has lighter symptoms or taken antibiotics already,the diagnostic capability of RADT may be depressed.