A族链球菌咽炎的临床诊断及评分制的应用进展

Clinical diagnosis of group A streptococcal pharyngitis and progress in the application of scoring systems

摘要:

咽炎可由病毒、细菌等多种病原感染引起，其中A族链球菌（group A streptococcus, GAS）是咽炎最常见的细菌性病原。基于症状和体征的临床诊断很难将GAS咽炎与其他原因咽炎截然分开，经验性治疗势必会导致抗菌药物的过度使用。随着国内抗菌药物管理工作和医保支付改革措施的深入，减少不必要的检测和抗菌药物处方势在必行。为促进GAS咽炎规范化诊治，该文梳理了国外不同指南中关于GAS咽炎临床诊断和鉴别诊断，尤其是指导GAS咽炎实验室检测和抗菌治疗决策的临床评分制及其应用建议，供国内同道开展研究和临床实践时参考。

Abstract:

Pharyngitis can be caused by various pathogens, including viruses and bacteria. Group A streptococcus (GAS) is the most common bacterial cause of pharyngitis. However, distinguishing GAS pharyngitis from other types of upper respiratory tract infections is challenging in clinical settings. This often leads to empirical treatments and, consequently, the overuse of antimicrobial drugs. With the advancement of antimicrobial drug management and healthcare payment reform initiatives in China, reducing unnecessary testing and prescriptions of antimicrobial drugs is imperative. To promote standardized diagnosis and treatment of GAS pharyngitis, this article reviews various international guidelines on the clinical diagnosis and differential diagnosis of GAS pharyngitis, particularly focusing on clinical scoring systems guiding laboratory testing and antimicrobial treatment decisions for GAS pharyngitis and their application recommendations, providing a reference for domestic researchers and clinical practitioners.