Hjortdahl P, Melbye H
Department of General Practice, University of Oslo, Norway.
Scand J Prim Health Care. 1994 Jun;12(2):70-6. doi: 10.3109/02813439409003678.
To asses the efficacy of near-to-patient laboratory testing in diagnosing group A beta haemolytic streptococci throat infection in adults, alone and in conjunction with the doctor's clinical judgement.
174 primary care patients with a sore throat, of which 59 (34%) were identified as having group A streptococci.
The erythrocyte sedimentation rate, leucocyte count, and C-reactive protein, and a specific streptococcal immunological assay were evaluated separately and in conjunction with the doctor's clinical diagnosis. The presence of GAS throat infection, the reference standard, was defined as those patients presenting with a chief complaint of sore throat and having a positive GAS culture or a four-fold or more increase or fall of AST or ADNase B serum levels during a four-week observation period.
The discriminatory ability of the sedimentation rate was not satisfactory and added little useful clinical information. Leucocytes and C-reactive protein both yielded clinically significant information and had similar test characteristics. The immunological test had the best characteristics of the tests evaluated.
Near-to-patient testing, except the erythrocyte sedimentation rate, may, in addition to the clinical evaluation, contribute to the differential diagnosis of streptococcal pharyngitis in adults.
评估即时检验在单独以及与医生临床判断相结合诊断成人A组β溶血性链球菌咽喉感染中的效果。
174名患有咽喉痛的初级保健患者，其中59名（34%）被确诊感染A组链球菌。
分别评估红细胞沉降率、白细胞计数、C反应蛋白以及一项特定的链球菌免疫测定，并将其与医生的临床诊断相结合。A组链球菌咽喉感染（参考标准）的存在定义为那些以咽喉痛为主诉且在四周观察期内A组链球菌培养呈阳性或抗链球菌溶血素O（AST）或脱氧核糖核酸酶B（ADNase B）血清水平升高或降低四倍及以上的患者。
红细胞沉降率的鉴别能力不尽人意，几乎未提供有用的临床信息。白细胞计数和C反应蛋白均产生了具有临床意义的信息，且具有相似的检测特征。免疫测定在所有评估检测中具有最佳特征。
除红细胞沉降率外，即时检验除临床评估外，可能有助于成人链球菌性咽炎的鉴别诊断。
