儿童发生咽痛和 A 组链球菌性咽炎与发生急性风湿热风险的相关性：系统评价和荟萃分析。
The incidence of sore throat and group A streptococcal pharyngitis in children at high risk of developing acute rheumatic fever: A systematic review and meta-analysis.
机构信息
Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.
出版信息
PLoS One. 2020 Nov 18;15(11):e0242107. doi: 10.1371/journal.pone.0242107. eCollection 2020.
BACKGROUND
Group A streptococcal (GAS) pharyngitis has traditionally been considered the sole precursor of acute rheumatic fever (ARF). Evidence from Australia, however, suggests that GAS skin infections may contribute to the pathogenesis of ARF. A missing piece of evidence is the incidence of sore throat and GAS pharyngitis in this setting. We conducted a systematic review and meta-analysis of the incidence of sore throat and GAS pharyngitis in all children at risk of developing ARF.
METHODS
Databases were systematically searched for studies reporting on the incidence of pharyngitis among children from low to upper-middle income countries, and Indigenous children living in high-income countries. Studies were subjected to data extraction by two independent reviewers. Following an assessment of the methodological quality of the studies, we extracted incidence rates (IRs) and conducted a meta-analysis. This systematic review is registered on PROSPERO (CRD42019113019).
RESULTS
From 607 titles identified by the search, 11 articles met the predetermined inclusion criteria; ten studies reported IRs while for the remaining study, the incidence was calculated. The pooled incidence estimated for sore throat was 82.5 per 100 child-years (95% confidence interval [CI], 6.5 to 1044.4 per 100 child-years, I2 = 100%) and GAS pharyngitis was 10.8 per 100 child-years (95% CI, 2.3 to 50.0 per 100 child-years, I2 = 99.9%).
CONCLUSIONS
The pooled IRs for sore throat in children at risk of developing ARF were higher than rates reported in developed nations (32.70-40 per 100 child-years) and similar for GAS pharyngitis (12.8-14 per 100 years). The limited Australian data lend support to the need for further studies to inform the role of GAS pharyngitis in the development of ARF in Australian Indigenous children, so as to inform local primary prevention strategies for ARF and Rheumatic Heart Disease (RHD).
背景
A 组链球菌（GAS）咽炎传统上被认为是急性风湿热（ARF）的唯一前驱疾病。然而，来自澳大利亚的证据表明，GAS 皮肤感染可能有助于 ARF 的发病机制。在此背景下，缺少的一个证据是该人群中咽痛和 GAS 咽炎的发生率。我们对所有有发生 ARF 风险的儿童中咽痛和 GAS 咽炎的发生率进行了系统评价和荟萃分析。
方法
系统检索了来自低收入到中上收入国家和高收入国家的土著儿童的报告 GAS 咽炎发生率的研究。由两名独立审查员进行数据提取。在评估了研究的方法学质量后，我们提取了发病率（IR）并进行了荟萃分析。本系统评价已在 PROSPERO（CRD42019113019）上注册。
结果
从搜索到的 607 个标题中，有 11 篇文章符合预定的纳入标准；10 项研究报告了发病率，而对于其余的研究，则计算了发病率。估计的咽痛总发病率为每 100 儿童年 82.5（95%置信区间[CI]，每 100 儿童年 6.5 至 1044.4；I2=100%），GAS 咽炎的发病率为每 100 儿童年 10.8（95%CI，每 100 儿童年 2.3 至 50.0；I2=99.9%）。
结论
发生 ARF 风险的儿童中咽痛的汇总发病率高于发达国家报告的发病率（32.70-40 每 100 儿童年），GAS 咽炎的发病率也相似（12.8-14 每 100 年）。澳大利亚的有限数据支持需要进一步研究，以了解 GAS 咽炎在澳大利亚土著儿童中发生 ARF 的作用，以便为 ARF 和风湿性心脏病（RHD）的当地一级预防策略提供信息。
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