症状和体征诊断链球菌性咽炎准确性的系统评价和Centor评分的验证  

A systematic review of the diagnostic accuracy of predicting streptococcal pharyngitis by symptoms and signs and validation of the Centor score

作　　者：丁繁[1] 王秋兰[2] 孟敏[3] DING Fan;WANG Qiulan;MENG Min(Clinical Skills Training Center,Gansu University of Chinese Medicine,Lanzhou,Gansu,730101,China;Department of Diagnostics,Gansu University of Chinese Medicine,Lanzhou,Gansu,730101,China;Department of Pharmacy,Gansu Provincial Hospital,Lanzhou,Gansu,730000,China)

机构地区：[1]甘肃中医药大学临床技能实训中心,甘肃兰州730101 [2]甘肃中医药大学诊断学教研室,甘肃兰州730101 [3]甘肃省人民医院药剂科,甘肃兰州730000

出　　处：《中国耳鼻咽喉头颈外科》2022年第3期199-204,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：甘肃省自然科学基金(18JR3RA195);甘肃省教育厅创新基金项目(2021B-164)。

摘　　要：目的 评估症状和体征的诊断准确性,并验证Centor评分用于预测出现咽喉痛症状A组β-溶血性链球菌咽炎(group A β-haemolytic streptococcal pharyngitis,GABHS)。方法 系统检索2000~2020年的文献,纳入评估体征和症状诊断准确性和/或验证Centor评分的研究。采用双变量随机效应模型分析症状体征和Centor评分的诊断准确性,采用随机效应模型对Centor评分进行校准分析。结果 共纳入15项研究,共计146 818例患者。症状和体征合并结果具有一定的异质性,表明个体的体征和症状与后验概率差别较小(+LR 1.79~2.60,-LR 0.40~0.75)。作为指导抗生素处方的临床决策规则(评分≥3),Centor评分具有合理的特异性(0.71,95%CI 0.62~0.80),并且基于5%~20%的患病率,得出后验概率为9%~25%。合并校准显示,评分为4分时预测和观察到的GABHS患者数量差异无统计学意义(RR 1.10,95%CI0.88-1.38)。结论 单独的体征和症状不足以区分GABHS和其他类型的咽喉痛。Centor评分是一种校准较好的临床预测规则,可用于估计GABHS咽炎的概率。Centor评分可以合理化抗生素处方,在低发病率的GABHS环境中(如社区医疗)应谨慎使用抗生素。OBJECTIVE To assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule(CPR),the Centor score,for predicting group A β-haemolytic streptococcal(GABHS) pharyngitis presenting with sore throat symptoms.METHODS A systematic literature search was performed from 2000 to 2020.Studies that assessed the diagnostic accuracy of signs and symptoms and(or) validated the Centor score were included.For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score,studies were combined using a bivariate random effects model,while for the calibration analysis of the Centor score,a random effects model was used.RESULTS A total of 15 studies incorporating 146 818 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms.The results were heterogeneous and suggested that individual signs and symptoms generate only small shifts in post-test probability range positive likelihood ratio(+LR1.79-2.60,-LR 0.40-0.75).As a decision rule for considering antibiotic prescribing(score≥3),the Centor score has reasonable specificity(0.71,95%CI,0.62-0.80) and a post-test probability of 9% to 25% based on a prior prevalence of 5%to 20%.Pooled calibration showed no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis when Centor score was 4(RR1.10,95%CI,0.88 to 1.38).CONCLUSION Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat.The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis.The Centor score can enhance appropriate prescribing of antibiotics,but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care.

关 键 词：体征和症状 诊断 A组β-溶血性链球菌咽炎 咽喉痛 Centor评分 

分 类 号：R766.14[医药卫生—耳鼻咽喉科]