基层医疗项目中的咽喉痛：一种诊断病毒性咽喉痛的临床评分
Sore throat in primary care project: a clinical score to diagnose viral sore throat.
作者信息
Mistik Selcuk, Gokahmetoglu Selma, Balci Elcin, Onuk Fahri A
机构信息
Department of Family Medicine,
Department of Microbiology.
出版信息
Fam Pract. 2015 Jun;32(3):263-8. doi: 10.1093/fampra/cmv015. Epub 2015 Mar 25.
OBJECTIVE
Viral agents cause the majority of sore throats. However, there is not currently a score to diagnose viral sore throat. The aims of this study were (i) to find the rate of bacterial and viral causes, (ii) to show the seasonal variations and (iii) to form a new scoring system to diagnose viral sore throat.
METHODS
A throat culture for group A beta haemolytic streptococci (GABHS) and a nasopharyngeal swab to detect 16 respiratory viruses were obtained from each patient. Over a period of 52 weeks, a total of 624 throat cultures and polymerase chain reaction analyses were performed. Logistic regression analysis was performed to find the clinical score.
RESULTS
Viral infection was found in 277 patients (44.3%), and GABHS infection was found in 116 patients (18.5%). An infectious cause was found in 356 patients (57.1%). Rhinovirus was the most commonly detected infectious agent overall (highest in November, 34.5%), and the highest GABHS rate was in November (32.7%). Analysis of data provided a scoring system, called the Mistik Score, to diagnose viral sore throat. The predictive model for positive viral analysis included the following variables: absence of headache, stuffy nose, sneezing, temperature of ≥37.5°C on physical examination, and the absence of tonsillar exudate and/or swelling. The probability of a positive viral analysis for a score of 5 was 82.1%.
CONCLUSION
The Mistik Score may be useful to diagnose viral sore throat. We suggest its use either alone or in combination with the Modified Centor Score.
目的
病毒病原体是导致大多数咽喉痛的原因。然而，目前尚无用于诊断病毒性咽喉痛的评分系统。本研究的目的是：（i）确定细菌和病毒病因的比例；（ii）展示季节性变化；（iii）形成一种用于诊断病毒性咽喉痛的新评分系统。
方法
从每位患者处获取A组β溶血性链球菌（GABHS）的咽喉培养物以及用于检测16种呼吸道病毒的鼻咽拭子。在52周的时间里，共进行了624次咽喉培养和聚合酶链反应分析。进行逻辑回归分析以确定临床评分。
结果
在277例患者（44.3%）中发现病毒感染，在116例患者（18.5%）中发现GABHS感染。在356例患者（57.1%）中发现有感染性病因。鼻病毒是总体上最常检测到的感染病原体（11月最高，为34.5%），GABHS感染率最高的是11月（32.7%）。数据分析提供了一种名为米斯蒂克评分（Mistik Score）的评分系统，用于诊断病毒性咽喉痛。病毒分析呈阳性的预测模型包括以下变量：无头痛、鼻塞、打喷嚏，体格检查时体温≥37.5°C，以及无扁桃体渗出物和/或肿胀。评分为5分时病毒分析呈阳性的概率为82.1%。
结论
米斯蒂克评分可能有助于诊断病毒性咽喉痛。我们建议单独使用或与改良森托评分（Modified Centor Score）联合使用。
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