症状和体征诊断链球菌性咽炎准确性的系统评价和Centor评分的验证

目的 评估症状和体征的诊断准确性,并验证Centor评分用于预测出现咽喉痛症状A组β-溶血性链球菌咽炎(group A β-haemolytic streptococcal pharyngitis,GABHS)。方法 系统检索2000~2020年的文献,纳入评估体征和症状诊断准确性和/或验证Centor评分的研究。采用双变量随机效应模型分析症状体征和Centor评分的诊断准确性,采用随机效应模型对Centor评分进行校准分析。结果 共纳入15项研究,共计146 818例患者。症状和体征合并结果具有一定的异质性,表明个体的体征和症状与后验概率差别较小(+LR 1.79~2.60,-LR 0.40~0.75)。作为指导抗生素处方的临床决策规则(评分≥3),Centor评分具有合理的特异性(0.71,95%CI 0.62~0.80),并且基于5%~20%的患病率,得出后验概率为9%~25%。合并校准显示,评分为4分时预测和观察到的GABHS患者数量差异无统计学意义(RR 1.10,95%CI0.88-1.38)。结论 单独的体征和症状不足以区分GABHS和其他类型的咽喉痛。Centor评分是一种校准较好的临床预测规则,可用于估计GABHS咽炎的概率。Centor评分可以合理化抗生素处方,在低发病率的GABHS环境中(如社区医疗)应谨慎使用抗生素。

每日一次阿莫西林可有效治疗链球菌性咽炎

美国Eastover儿科医院的Herbert W．Clegg博士及其同事在9月的《传染病杂志》（Pediatr Infect Dis J，2006；25：761—767．）上报告，治疗A组链球菌性咽炎，阿莫西林每日1次不亚于每日2次方案。

用头孢布坦及阿齐红霉素对儿童链球菌性咽炎的短期治疗

目的：比较短期（5天）使用头孢布坦与使用阿齐红霉素3天，在治疗儿童A群β-溶血性链球菌（GABHS）咽炎中的安全性与有效性。方法：是一候多中心的，开放标记的，预测性的随机试验，在证实有GABHS咽炎的≥3岁，≤16岁的患者中，随机地接受每天一次头孢布坦共5天，或阿齐红霉素组有116个患者参与安全性分析，参与头孢布坦和阿齐红霉素有效性评估的分别有126例和101例，在两组中，第6-8天记录的临床成功（治疗组明显改善）分别是98%和94%，在第6-8天的细菌学有效性分析中，GABHS菌株在76%的用头孢布坦治疗的患者中得以根除，在接受阿齐红霉素的也有76%，在第33-35天，头孢布坦组84%的患者和阿齐红霉素组71%的患者GABHS阴性，在头孢布坦和阿齐红霉素病例中观察到的细菌学复发分别为4%和7%，在所有患者中两种治疗都有良好的耐受性。结论：头孢布坦和阿齐红霉素都是简单的治疗方案（一天使用1次，治疗时间短），在使用头孢布坦后记录到相对较高的清除率，与体外研究结果相一致。体外研究发现，与大环内酯类相比，β-内酰胺类对GABHS有很高的细菌性活性。

儿科临床实践中可能的A族链球菌性咽炎与快速抗原检测试验的敏感性之间的关系

Objective.The sensitivity of a rapid antigen-detection test(RADT)for group A streptococcal(GAS)pharyngitis is critical to whether the test is cost-effe ctive and to whether a confirmatory throat culture is needed.We evaluated a second-generation RADT to determine if its sensitivity varies across the broa d clinical spectrum of patients tested for GAS in pediatric outpatient practice.Methods.We used laboratory logbooks from a single pediatric clinic to identify 1184 consecutive patient visits at which an RADT was performed.In a blinded ch art review,we calculated McIsaac scores to separately estimate the pretest clin ical likelihood of GAS pharyngitis for visits at which the RADT result was posit ive(n = 384)and for visits at which the result proved to be false-negative(n = 65).Positive RADT results were assumed to be true positives,and test sensit ivity was estimated by dividing the number of positive results by the sum of pos itives and false-negatives.Results.As the clinical likelihood of GAS increase d,there were stepwise increases in RADT sensitivity(from 0.67 to 0.88).Sensit ivity was low(0.73;95%confidence interval [CI]:0.62-0.86)in patients clini cally unlikely to have GAS(McIsaac score ≤2)and high(0.94;95%CI:0.89-0.9 9)in patients < 15 years old who had tonsillar exudate and no cough.False-neg ative RADT results were associated with lighter growth of GAS than found on spec imens obtained from a random sample of clinic patients who had only primary thro at cultures ordered.Conclusions.For pediatric patients who are clinically unli kely to have GAS pharyngitis,as indicated by a McIsaac score ≤2,the sensitivi ty of a second-generation RADT may drop below thresholds reported for cost-eff ectiveness.For children who have tonsillar exudate and no cough,the test may b e sensitive enough to meet current pediatric practice guidelines for stand-alon e testing.

儿童群体中快速抗原检测试验对于诊断A组β-溶血性链球菌性咽炎的疾病谱的偏倚

Background.Rapid antigen detection testing (RADT) is often performed for diagnosis of group A β-hemolytic streptococcal (GABHS) pharyngitis among children.Among adults, the sensitivity of this test varies on the basis of disease severity (spectrum bias).A similar phenomenon may occur when this test is used in a pediatric population, which may affect the need for culture confirmation of all negative RADT results.Objectives.To assess the performance of a clinical scoring system and to determine whether RADT spectrum bias is present among children who are evaluated for GABHS pharyngitis.Methods.Laboratory and clinical records for a consecutive series of pediatric patients who underwent RADT at the Marshfield Clinic between January 2002 and March 2002 were reviewed retrospectively.Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy.The sensitivity of the RADT was defined as the number of patients with positive RADT results divided by the number of patients with either positive RADT results or negative RADT results but positive throat culture results.Results.RADT results were positive for 117 of 561 children (21%), and culture results were positive for 35 of 444 children (8%) with negative RADT results.The over-all prevalence of GABHS pharyngitis was 27%(95%confidence interval: 23-31%).The prevalence of GABHS pharyngitis was 18%among patients with 0 Centor criteria, 16%among those with 1 criterion, 32%among those with 2 criteria, and 50%among those with 3 or 4 criteria.Spectrum bias was present, inasmuch as RADT sensitivity increased with Centor scores, ie, 47%sensitivity among children with 0 Centor criteria, 65%among those with 1 criterion, 82%among those with 2 criteria, and 90%among those with 3 or 4 criteria.Conclusions.The sensitivity of RADT for GABHS pharyngitis is not a fixed value but varies with the severity of disease.However, even among pediatric patients with ≥3 Centor criteria for GABHS pharyngitis, the sensitivity of RADT is still too low to support the use of RADT without culture confirmation of negative results.

对链球菌性咽炎的WHO临床诊断规则的评价

Aims: To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS)-pharyngitis in three countries. Methods: A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis. Results: The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low(0.0-4.6% ) Specificity was high in both age groups in all countries (93.8-97.4% ). Conclusions: In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.

5个美国健康计划中治疗A型链球菌性咽炎效果的测定

Background: There is a high degree of professional consensus that children dia gnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). Objectives: To develop and test the validity of a quality of care performance measure that examines GAS testing ra tes in children diagnosed with pharyngitis and prescribed an antibiotic. Design: The measure developed examines the annual rate of GAS testing in children aged 2 to 18 years with an episode of pharyngitis who were prescribed antibiotics. Th e measure was tested for feasibility of implementation and validity in 5 health plans in the United States. Health plan administrative data were used to identif y episodes of pharyngitis using International Classification of Diseases, Ninth Revision (ICD-9) codes 462, 463, and 034.0. Pharmacy data (National Drug Codes) were used to determine if antibiotics were prescribed for the pharyngitis episo de. Laboratory claims data (Current Procedural Terminology codes) were used to d etermine whether a GAS test was performed. Rates of GAS testing in children with pharyngitis who received antibiotics were calculated for each health plan. Medi cal record abstractions were performed on a random sample (n = 465) of cases to assess percent agreement with laboratory claims data for GAS testing. Sensitivit y of the administrative data for accurately identifying when GAS tests were perf ormed was also assessed. Results: Of the 120 158 children aged 2 to 18 years who had at least 1 episode of pharyngitis during the measurement year, 51172 (43%) received antibiotics. Group A streptococcal testing rates for patients who were prescribed antibiotics varied widely among the participating health plans (59% -83%of cases; P<.05). Percent agreement between administrative and medical rec ords data for GAS tests was 86%. The sensitivity of the administrative data for accurately identifying when GAS tests were performed was 85%. Conclusions: Thi s quality measure is feasible to implement at the health plan level and validly assesses GAS testing rates using administrative data. The participating health p lans are not performing GAS tests as indicated by current expert practice guidel ines in a substantial proportion of cases. Improvements in adhering to these gui delines are warranted given the current levels of antibiotic overuse and antibio tic resistance nationally.

在缺乏检查设备的条件下处理链球菌性咽炎的临床决策规则

Background: Most of the world’s children live in regionswhere laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians’decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. Methods: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. Results: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92%sensitivity and 38%specificity in these children. Conclusions: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90%of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.

资阳地区儿童链球菌性咽炎临床分布特点与季节气候的关系

目的 研究资阳地区儿童链球菌性咽炎临床分布特点与季节气候的相关性,为防治儿童链球菌性咽炎疾病提供依据。方法 采用多阶段分层随机方式对2022年1月至2023年1月资阳市第一人民医院就诊的583例链球菌性咽炎患儿进行调查,收集其临床资料,并对患儿进行咽拭子链球菌培养;统计每季节链球菌性咽炎发病例数,记录同期的平均气压、温度、降雨量及风速;采用Pearson法分析单个气候因素与链球菌性咽炎发病的相关性。结果 583例患儿中男童329例、女童254例;发病年龄主要为7~12岁,共227例(38.94%),其次为3~6岁199例(34.13%),1~2岁126例(21.61%),<1岁31例(5.32%);链球菌培养检出614株病原菌,主要为溶血性链球菌,共479株,占比78.01%,其次为化脓性链球菌,共175株,占比28.50%。患儿春季发病192例、夏季51例、秋季72例、冬季268例;资阳地区春冬季平均风速、气压更高,夏秋季平均气温、降雨量更高。经Pearson相关性分析,患儿发病与平均风速、气压呈正相关(P<0.05),与平均温度、降雨量呈负相关(P<0.05)。结论 资阳地区链球菌性咽炎多发于5岁以上儿童,主要病原菌为溶血性链球菌,春冬季节发病,与该地区季节气候密切相关。

阿奇霉素治疗儿童化脓性咽炎疗效观察

儿童细菌性咽炎的病原中化脓性链球菌列首位,目前青霉素和其他β内酰胺类抗生素对化脓性链球菌仍保持近乎100%的敏感性,因此被推荐为治疗化脓性链球菌咽炎的首选药物。但门诊患儿有对β内酰胺类抗生素过敏者,则大环内酯类抗生素是主要的替代治疗药物。我们观察了阿奇霉素治疗儿童化脓性咽炎（或扁桃体炎）效果及副作用,现报告如下。

广州市部分中小学生风湿热与风湿性心脏病流行病学调查

风湿热(RF)与凤湿性心脏病(RHD)是危害青少年的常见心血管病之一.为了解其流行情况,我们于1984年3～6月在广州市中小学生中进行了流行病学调查。资料与方法对象是广州市越秀区8所中学和13所小学的6～18岁全部学生,共18,658人,普查率达99.9％.调查按统一表格填写,小学生表格由家长填写,中学生由本人填写。学生检查时医务人员逐项补充询问并核实。体检着重于体温、扁桃腺、皮肤、关节、肢体活动及心脏。

American Family Physician 2016年7月目次选登

July 1,2016·Common Questions About Streptococcal Pharyngitis链球菌性咽炎常见问题·Cardiac Rehabilitation：Improving Function and Reducing Risk心脏康复：改善功能和降低风险·Diagnosis and Management of Vertebral Compression Fractures椎体压缩性骨折的诊断和管理·FDA Implements New Labeling for Medications Used During Pregnancy and Lactation美国食品药品监督管理局落实孕期哺乳期药物使用新标签，

咽科学、咽疾病

0203241 幼儿周期性发烧和咽炎:是耳鼻喉科学家的一种新的疾病吗?/Dahn KA∥Arch Otolaryngol Head Neck Surg.-2000,126(9).-1146～1149 西交图0203242 合理的临床检查。这个病人患有链球菌性咽炎吗?/Ebell M H∥JAMA.-2000,284(22).-2912～2918