Ruiz-Aragón J, Rodríguez López R, Molina Linde J M
Agencia de Evaluación de Tecnología Sanitaria de Andalucía (AETSA), Sevilla, España.
An Pediatr (Barc). 2010 Jun;72(6):391-402. doi: 10.1016/j.anpedi.2009.12.012. Epub 2010 Mar 25.
Streptococcal pharyngitis is one of the most frequent reasons for consultations in primary and paediatric care. An inadequate treatment could cause adverse effects and bacterial resistance. The rapid antigen tests are an important advance, enabling the diagnosis of infection by Streptococcus pyogenes to be diagnosed in a few minutes. The aim of this review is to assess the rapid antigen-detection test in the diagnosis of S. pyogenes from throat samples.
Systematic review and meta-analysis (2000-09). Source database: MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes and HTA's agencies. The quality of included studies was measured according to Quadas's criteria. The diagnostic validity indices have been calculated. A meta-analysis was performed in order to synthesize the results of the different evaluated studies.
Twenty four studies were included. The quality was moderate. The sensitivity ranged between 65.6% and 96.4%; specificity from 68.7%-99.3%; the positive predictive value was between 59.4%-97.4%; and the negative predictive value from 87.8%-98%. The meta-analysis determined an overall sensitivity of 0.85 [95% CI, 0.84-0.87], specificity was 0.96 [95% CI, 0.96-0.97], likelihood ratio (+) 22.21 [95% CI, 15.12-32.63], and likelihood ratio (-) 0.15 [95% CI, 0.13-0.18]. The rapid antigen-detection test demonstrated a good diagnostic performance.
Rapid tests offer good accuracy for use as diagnostic method, however, these devices have to be complemented with the microbiological culture, because there are false positive and negative results.
链球菌性咽炎是基层医疗和儿科医疗中最常见的就诊原因之一。治疗不当可能会导致不良反应和细菌耐药性。快速抗原检测是一项重要进展，能够在几分钟内诊断出化脓性链球菌感染。本综述的目的是评估快速抗原检测在从咽喉样本中诊断化脓性链球菌方面的应用。
系统评价和荟萃分析（2000 - 2009年）。来源数据库：医学在线数据库（MedLine）、荷兰医学文摘数据库（Embase）、考克兰图书馆（Cochrane Library）、护理学与健康领域数据库（Cinahl）、英国约克大学的循证卫生保健中心数据库（CRD）、美国医疗卫生研究与质量机构（ECRI）、海斯咨询公司（Hayes）以及英国国家卫生与临床优化研究所（HTA）的机构数据库。根据夸达斯（Quadas）标准评估纳入研究的质量。计算诊断有效性指标。进行荟萃分析以综合不同评估研究的结果。
纳入24项研究。质量中等。敏感性在65.6%至96.4%之间；特异性在68.7%至99.3%之间；阳性预测值在59.4%至97.4%之间；阴性预测值在87.8%至98%之间。荟萃分析确定总体敏感性为0.85[95%置信区间，0.84 - 0.87]，特异性为0.96[95%置信区间，0.96 - 0.97]，阳性似然比为22.21[95%置信区间，15.12 - 32.63]，阴性似然比为0.15[95%置信区间，0.13 - 0.18]。快速抗原检测显示出良好的诊断性能。
快速检测作为诊断方法具有良好的准确性，然而，由于存在假阳性和假阴性结果，这些检测手段必须辅以微生物培养。
