儿童A族链球菌咽扁桃体炎临床诊疗专家共识（2025）
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中华儿科杂志 2025年5月第63卷第5期 Chin J Pediatr, May 2025, Vol. 63, No. 5
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推荐意见与 GRADE 证据分级
| # | 推荐意见 | 证据等级 | 出处 |
|---|---|---|---|
| 1 | 细菌性咽扁桃体炎最常见的病原体为GAS,C族链球菌(Group C Streptococcus, GCS)及G族链球菌(Group G Streptococcus, GGS)亦属于较为常见的病原体。 | — | |
| 2 | GAS主要通过呼吸道飞沫接触传播,也可通过污染的食物、物品间接传播。 | — | |
| 3 | 当患儿出现急性发热、咽痛、扁桃体肿大渗出、颈部淋巴结肿大伴触痛等临床表现时,应考虑GAS咽扁桃体炎。 | — | |
| 4 | Centor评分与Mclsaac评分作为预测GAS咽扁桃体炎的有效工具,已被广泛应用于临床实践中,旨在辅助临床医师作出是否进行实验室检测及使用抗菌药物的决策,但这两项评分的验证仅限于高收入国家,其适用性和准确性在其他经济水平地区的推广需进一步验证。 | — | |
| 5 | GAS咽扁桃体炎病原学诊断方法主要包括传统的细菌培养和RADT,核酸检测可作为GAS感染确诊的病原学依据。抗链球菌溶血素O(antistreptolysin O, ASO)抗体检测一般只可作为既往GAS感染的证据。 | — | |
| 6 | 临床诊断病例:需满足发热、咽痛、扁桃体肿大并伴有渗出物、颈部淋巴结肿大并伴有触痛、外周血中白细胞计数及中性粒细胞比例升高。若患儿在急性发热的24h内,同时出现弥漫性充血的皮肤上粟粒样丘疹、杨梅舌、口周苍白圈 | — | |
| 7 | 确诊病例:GAS咽扁桃体炎临床诊断病例,同时具有以下任一病原学检测结果阳性:(1)咽扁桃体拭子或分泌物培养到GAS;(2)咽拭子GAS的RADT检测呈阳性;(3)咽拭子GAS核酸检测阳性;(4)恢复期较急性期ASO阳转或滴度呈2倍及以上升高。 | — | |
| 8 | 少数患儿可反复发生GAS咽扁桃体炎,可能与抗感染治疗不充分及从密切接触者或环境中再次感染有关。 | — | |
| 9 | 将咽拭子GAS培养结果呈阳性,或GAS的RADT结果为阳性,但无GAS感染相应的临床表现者,定义为GAS咽部携带者,包括那些虽已接受针对GAS感染的有效抗菌药物足疗程治疗,但其检测结果仍为阳性者。 | — | |
| 10 | 在确诊为GAS咽扁桃体炎时,推荐优先选择青霉素类药物。若患儿存在青霉素过敏史,则头孢类抗菌药物可作为备选。 | — | |
| 11 | GAS咽扁桃体炎确诊患儿或存在风湿热家族史或高危因素的无症状GAS携带患儿。 | — | |
| 12 | 长效青霉素可作为GAS咽扁桃体炎选择治疗方案之一,也可用于风湿热的二级预防。 | — | |
| 13 | ASO检测常用于ARF和肾小球肾炎的辅助诊断,当滴度2倍或以上升高可考虑有GAS前驱感染,而ASO阴性不能除外GAS感染。不推荐ASO用于GAS急性期感染诊断。 | — | |
| 14 | GAS咽扁桃体炎的并发症包括化脓性并发症及非化脓性并发症。化脓性并发症包括扁桃体周围脓肿或咽后壁脓肿、皮肤软组织感染、蜂窝织炎、鼻窦炎、中耳炎、颈淋巴结炎、菌血症、肺炎以及脑膜炎等。非化脓性并发症包括ARF、PSGN、链球菌感染后反应性关节炎、链球菌中毒性休克综合征以及GAS感染相关的儿童自身免疫性神经精神障碍(pediatric autoimmune neuropsychiatric disorder associated with Group A Streptococci, PANDAS)等。 | — |
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引用 / 出处
佚名. 儿童A族链球菌咽扁桃体炎临床诊疗专家共识（2025）[J]. 中华儿科杂志, 2025.