Dagnelie C F, Bartelink M L, van der Graaf Y, Goessens W, de Melker R A
Department of General Practice, University of Utrecht, The Netherlands.
Br J Gen Pract. 1998 Feb;48(427):959-62.
Sore throat is a common complaint in general practice. However, management strategies are not very clear. A better diagnostic procedure is needed to prevent the overuse of antibiotics.
To assess the diagnostic value of a rapid streptococcal antigen detection test in addition to four clinical features in patients with sore throat, using throat culture and antibody titres as reference tests.
Four clinical features [fever (history) > or = 38.0 degrees C, lack of cough, tonsillar exudate, and anterior cervical lymphadenopathy] were registered in 558 patients aged 4 to 60 years presenting with sore throat of no more than 14 days' duration. A rapid diagnostic test was performed, as well as a throat culture and antibody titres [fourfold increase in anti-streptolysin-O (ASO) and/or anti-deoxyribonuclease B (anti-DNAase B)] in patients aged 11 years and older.
Throat cultures were positive for group A beta-haemolytic streptococcus (GABHS) in 33% of the patients. Rapid tests were positive in 24%. Compared with the throat culture, the sensitivity of the rapid test was 65%, the specificity 96%, the positive predictive value 88%, and the negative predictive value 85%. However, for patients with three or four clinical features, the sensitivity of the rapid test was considerably higher at 75%. Children (< or = 14 years) had a slightly raised specificity and raised positive predictive value and prevalence. With the antibody titres as a reference, the rapid test performed as well as the throat culture with regard to its predictive value.
For the management of patients with sore throat in general practice, a rapid test may have an additional value, especially in patients with a high chance of having GABHS infection. However, as the sensitivity of the test studied is low, tests with a higher sensitivity are needed.
咽痛是全科医疗中常见的主诉。然而，管理策略并不十分明确。需要一种更好的诊断方法来防止抗生素的过度使用。
以咽拭子培养和抗体滴度作为参考检测，评估快速链球菌抗原检测试验联合四项临床特征对咽痛患者的诊断价值。
对558例年龄在4至60岁、咽痛持续时间不超过14天的患者记录四项临床特征[发热（病史）≥38.0℃、无咳嗽、扁桃体渗出物和颈前淋巴结病]。对患者进行快速诊断试验、咽拭子培养以及对11岁及以上患者检测抗体滴度[抗链球菌溶血素O（ASO）和/或抗脱氧核糖核酸酶B（抗DNA酶B）升高四倍]。
33%的患者咽拭子培养A组β溶血性链球菌（GABHS）呈阳性。快速检测阳性率为24%。与咽拭子培养相比，快速检测的灵敏度为65%，特异度为96%，阳性预测值为88%，阴性预测值为85%。然而，对于具有三项或四项临床特征的患者，快速检测的灵敏度显著更高，为75%。儿童（≤14岁）的特异度、阳性预测值和患病率略有升高。以抗体滴度作为参考，快速检测在预测价值方面与咽拭子培养相当。
对于全科医疗中咽痛患者的管理，快速检测可能具有附加价值，尤其是在GABHS感染可能性高的患者中。然而，由于所研究检测的灵敏度较低，需要灵敏度更高的检测。
