咽炎：修订间差异
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小 →细菌性 标签：2017年版源代码编辑 |
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;;链球菌性咽炎 |
;;链球菌性咽炎 |
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{{Main|链球菌性咽炎}}[[File:Pos strep.JPG|thumb| |
{{Main|链球菌性咽炎}}[[File:Pos strep.JPG|thumb|一例链球菌性咽喉炎]] |
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链球菌性咽炎或链球菌性咽喉炎是由{{Tsl|en|Streptococcus pyogenes|化脓性链球菌}}引起的。<ref name=Review10>{{cite journal | author = Baltimore RS | title = Re-evaluation of antibiotic treatment of streptococcal pharyngitis | journal = Curr. Opin. Pediatr. | volume = 22 | issue = 1 | pages = 77–82 | date = February 2010 | pmid = 19996970 | doi = 10.1097/MOP.0b013e32833502e7 | s2cid = 13141765 }}</ref>它是咽炎病例最常见的细菌原因（15-30%）。 <ref name=NEJM2001/>常见症状包括发烧、喉咙痛和淋巴结肿大。 它是一种传染性感染，通过与感染者的密切接触传播。 根据{{Tsl|en|throat culture|咽喉细菌培养}}结果作出明确诊断。 [[抗细菌药|抗生素]]可用于预防并发症（如[[風溼熱|风湿热]]）和加速康复。<ref name=Review09>{{cite journal | author = Choby BA | title = Diagnosis and treatment of streptococcal pharyngitis | journal = Am Fam Physician | volume = 79 | issue = 5 | pages = 383–90 | date = March 2009 | pmid = 19275067 | url = http://www.aafp.org/afp/2009/0301/p383.html | url-status = live | archive-url = https://web.archive.org/web/20150208124744/http://www.aafp.org/afp/2009/0301/p383.html | archive-date = 8 February 2015}}</ref> |
链球菌性咽炎或链球菌性咽喉炎是由{{Tsl|en|Streptococcus pyogenes|化脓性链球菌}}引起的。<ref name=Review10>{{cite journal | author = Baltimore RS | title = Re-evaluation of antibiotic treatment of streptococcal pharyngitis | journal = Curr. Opin. Pediatr. | volume = 22 | issue = 1 | pages = 77–82 | date = February 2010 | pmid = 19996970 | doi = 10.1097/MOP.0b013e32833502e7 | s2cid = 13141765 }}</ref>它是咽炎病例最常见的细菌原因（15-30%）。 <ref name=NEJM2001/>常见症状包括发烧、喉咙痛和淋巴结肿大。 它是一种传染性感染，通过与感染者的密切接触传播。 根据{{Tsl|en|throat culture|咽喉细菌培养}}结果作出明确诊断。 [[抗细菌药|抗生素]]可用于预防并发症（如[[風溼熱|风湿热]]）和加速康复。<ref name=Review09>{{cite journal | author = Choby BA | title = Diagnosis and treatment of streptococcal pharyngitis | journal = Am Fam Physician | volume = 79 | issue = 5 | pages = 383–90 | date = March 2009 | pmid = 19275067 | url = http://www.aafp.org/afp/2009/0301/p383.html | url-status = live | archive-url = https://web.archive.org/web/20150208124744/http://www.aafp.org/afp/2009/0301/p383.html | archive-date = 8 February 2015}}</ref> |
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;;其他 |
;;其他 |
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其他一些原因很少见，但可能致命，包括{{Tsl|en|parapharyngeal space|咽旁间隙}}感染：{{Tsl|en|Peritonsillar abscess|扁桃体周围脓肿}}（“昆西脓肿”）、{{Tsl|en|submandibular space infection|下颌下间隙感染}}（Ludwig心绞痛）和[[會厭炎|会厌炎]]。<ref>{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result |title=UpToDate Inc. |url-status=live |archive-url=https://web.archive.org/web/20090627030426/http://www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result |archive-date=27 June 2009}} (registration required)</ref><ref>{{cite journal |vauthors=Reynolds SC, Chow AW | title = Severe soft tissue infections of the head and neck: a primer for critical care physicians | journal = [[Lung (journal)|Lung]] | volume = 187 | issue = 5 | pages = 271–9 | date = Sep–Oct 2009 | pmid = 19653038 | doi = 10.1007/s00408-009-9153-7 | s2cid = 9009912 }}</ref><ref>{{cite journal |vauthors=Bansal A, Miskoff J, Lis RJ | title = Otolaryngologic critical care | journal = [[Crit Care Clin]] | volume = 19 | issue = 1 | pages = 55–72 | date = January 2003 | pmid = 12688577 | doi = 10.1016/S0749-0704(02)00062-3 }}</ref> |
其他一些原因很少见，但可能致命，包括{{Tsl|en|parapharyngeal space|咽旁间隙}}感染：{{Tsl|en|Peritonsillar abscess|扁桃体周围脓肿}}（“昆西脓肿”）、{{Tsl|en|submandibular space infection|下颌下间隙感染}}（Ludwig心绞痛）和[[會厭炎|会厌炎]]。<ref>{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result |title=UpToDate Inc. |url-status=live |archive-url=https://web.archive.org/web/20090627030426/http://www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result |archive-date=27 June 2009}} (registration required)</ref><ref>{{cite journal |vauthors=Reynolds SC, Chow AW | title = Severe soft tissue infections of the head and neck: a primer for critical care physicians | journal = [[Lung (journal)|Lung]] | volume = 187 | issue = 5 | pages = 271–9 | date = Sep–Oct 2009 | pmid = 19653038 | doi = 10.1007/s00408-009-9153-7 | s2cid = 9009912 }}</ref><ref>{{cite journal |vauthors=Bansal A, Miskoff J, Lis RJ | title = Otolaryngologic critical care | journal = [[Crit Care Clin]] | volume = 19 | issue = 1 | pages = 55–72 | date = January 2003 | pmid = 12688577 | doi = 10.1016/S0749-0704(02)00062-3 }}</ref> |
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===真菌性=== |
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有些咽炎是由[[真菌感染]]引起的，如[[白色念珠菌]]，引起[[鵝口瘡|口腔鹅口疮]]。<ref>{{cite web |last1=Harvard Medical School |title=Sore Throat (Pharyngitis) |url=https://www.health.harvard.edu/a_to_z/sore-throat-pharyngitis-a-to-z |website=Harvard Health Publishing Harvard Medical School |publisher=Harvard Health Publishing |access-date=3 December 2019}}</ref> |
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=== 非感染性 === |
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咽炎也可能由机械、化学或热刺激引起，例如冷空气或[[胃食道逆流]]。一些药物可能产生咽炎，如{{Tsl|en|Pramipexole|普拉克索}}和[[抗精神病药]]。<ref>{{cite web |url=http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Mirapex/Mirapex.pdf |title=Mirapex product insert |year=2009 |publisher=Boehringer Ingelheim |access-date=30 June 2010 |url-status=live |archive-url=https://web.archive.org/web/20100614020208/http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf |archive-date=14 June 2010 }}</ref><ref>{{cite web |url=http://medical-dictionary.thefreedictionary.com/olanzapine |title=Mosby's Medical Dictionary, 8th edition |year=2009 |publisher=Elsevier |access-date=30 June 2010}}</ref> |
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== 诊断 == |
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{| class="wikitable" style = "float: right; margin-left:15px; text-align:center" |
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|+ 修正后的Centor得分 |
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!积分||链球菌感染概率||处理手段 |
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| 1或更少|| <10%||不需要抗生素或培养 |
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| 2 ||11–17%||rowspan="2"|基于培养或{{Tsl|en|Rapid antigen test|快速抗原试验}}的抗生素 |
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| 3 ||28–35% |
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| 4或5 ||52%||{{Tsl|en|Empiric therapy|经验性治疗}} |
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[[File:Throat Culture.png|thumbnail|咽拭子]] |
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仅根据症状很难区分引起喉咙痛的病毒和细菌原因。<ref name="IDSA2012">{{cite journal|title=Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America.|date=9 September 2012|journal=Clinical Infectious Diseases|issue=10|doi=10.1093/cid/cis629|volume=55|pages=e86–102|pmc=7108032|pmid=22965026|vauthors=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C|doi-access=free}}</ref>因此，通常用{{Tsl|en|Sampling (medicine)|取样 (医学)|取样}}来排除细菌的原因。<ref name="pmid1565052">{{cite journal | author = Del Mar C | title = Managing sore throat: a literature review. I. Making the diagnosis | journal = [[Medical Journal of Australia]] | volume = 156 | issue = 8 | pages = 572–5 | year = 1992 | pmid = 1565052 | doi = 10.5694/j.1326-5377.1992.tb121422.x}}</ref> |
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修改后的{{Tsl|en|Centor criteria|Centor标准}}可用于确定咽炎患者的治疗方法。根据五项临床标准，它表明链球菌感染的可能性。<ref name=Review09/> |
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每项标准得1分：<ref name=Review09/> |
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* 没有咳嗽 |
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* {{Tsl|en|Cervical lymph nodes|颈部淋巴结}}肿痛 |
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* 温度超过 {{convert|38.0|C|F}} |
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* 扁桃体渗出或肿胀 |
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* 年龄小于15岁（如果年龄大于44岁，则减去一分） |
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{{Tsl|en|Infectious Disease Society of America|美国传染病协会}}建议不要进行{{Tsl|en|Empiric therapy|经验性治疗}}，认为只有在检测呈阳性后才适合使用抗生素。三岁以下的儿童不需要检测，因为A组链球菌和[[風溼熱|风湿热]]都很罕见，除非他们有一个患有该病的兄弟姐妹。<ref name="IDSA2012">{{cite journal |vauthors=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C | title = Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. | journal = Clinical Infectious Diseases | volume = 55 | issue = 10 | pages = e86–102 | date = 9 September 2012 | pmid = 22965026 | doi = 10.1093/cid/cis629 | pmc = 7108032 | doi-access = free }}</ref> |
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==处理手段== |
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大多数情况下，治疗是对症的。 特定治疗对细菌、真菌和[[单纯疱疹]]感染有效。 |
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===药物治疗=== |
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*'''[[镇痛药]]'''，如[[非甾体抗炎药]]和[[对乙酰氨基酚|对乙酰氨基酚（扑热息痛）]]，可以帮助减轻与喉咙痛有关的疼痛。阿司匹林可用于成人，但由于有[[雷氏症候群|雷尔氏综合征]]的风险，不建议用于儿童。<ref>{{cite journal|title=Re-evaluation of antibiotic treatment of streptococcal pharyngitis|date=February 2010|issue=Curr. Opin. Pediatr. 22 (1)|pages=77–82|doi=10.1097/MOP.0b013e32833502e7|pmid=19996970|volume=22|author=Baltimore RS|journal=Current Opinion in Pediatrics|s2cid=13141765}}</ref> |
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*[[甾体|类固醇]]（如[[地塞米松]]）可能对严重咽炎有用。<ref>{{cite journal |vauthors=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P | title = Corticosteroids for pain relief in sore throat: systematic review and meta-analysis | journal = BMJ | volume = 339 | pages = b2976 | year = 2009 | pmid = 19661138 | pmc = 2722696 | doi = 10.1136/bmj.b2976 }}</ref><ref name=":0" />然而，它们的普遍使用缺乏支持。<ref name="ReferenceA"/> |
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*粘性[[利多卡因]]通过麻痹黏膜来缓解疼痛。<ref>{{cite web |url=http://www.medicinenet.com/lidocaine_viscous/article.htm |title=LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions. |url-status=live |archive-url=https://web.archive.org/web/20100408065631/http://www.medicinenet.com/lidocaine_viscous/article.htm |archive-date=8 April 2010 }}</ref> |
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*如果喉咙痛是由细菌感染引起的，[[抗细菌药|抗生素]]是有用的。<ref>{{cite journal|last1=Kocher|first1=JJ|last2=Selby|first2=TD|title=Antibiotics for sore throat.|journal=American Family Physician|date=1 July 2014|volume=90|issue=1|pages=23–4|pmid=25077497}}</ref><ref>{{cite journal|last1=Spinks|first1=A|last2=Glasziou|first2=PP|last3=Del Mar|first3=CB|title=Antibiotics for sore throat.|journal=The Cochrane Database of Systematic Reviews|date=5 November 2013|volume=11|issue=11|pages=CD000023|pmid=24190439|pmc=6457983|doi=10.1002/14651858.CD000023.pub4}}</ref>对于病毒感染，抗生素没有效果。在美国，25%的人在发现细菌感染之前使用了抗生素。<ref>{{cite journal|last1=Urkin|first1=J|last2=Allenbogen|first2=M|last3=Friger|first3=M|last4=Vinker|first4=S|last5=Reuveni|first5=H|last6=Elahayani|first6=A|title=Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases.|journal=Acta Paediatrica|date=November 2013|volume=102|issue=11|pages=1075–80|pmid=23879261|doi=10.1111/apa.12364|s2cid=24465793}}</ref> |
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*口服镇痛剂溶液，其有效成分通常是[[苯酚]]，但也有不太常见的[[苯佐卡因]]、[[西吡氯铵]]和/或[[薄荷醇]]。{{Tsl|en|Chloraseptic|Chloraseptic}}和{{Tsl|en|Cēpacol|思必乐}}是这类镇痛剂品牌的两个例子。 |
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=== 替代疗法 === |
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{{see also|Alternative treatments used for the common cold}} |
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经常有人建议用[[鹽水|盐水]]漱口，但缺乏证明其作用的证据。<ref name=Web2014/>[[替代医学]]被提倡并用于治疗咽喉疼痛。然而，它们没有得到充分的证据支持。<ref name="mayo">{{cite web|title=Sore throat: Self-care|url=http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10|access-date=17 September 2007|publisher=[[Mayo Clinic]]|archive-url=https://web.archive.org/web/20070929153814/http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION%3D10|archive-date=29 September 2007|url-status=live}}</ref> |
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<!--Please include appropriate reference if found for: a peer-reviewed study or verifiable documentation regarding the effects of [[gargling]] with warm salt water. Comment: The Mayo Clinic says they are used but not effective. ... Reply from CyclePat: I can't find this in at the reference provided (for the gargling). I will look into it again though. It is hear but I do not think this is a good enough ref http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=lifestyle-and-home-remedies --> |
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== 流行病学 == |
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急性咽炎是导致[[咽喉痛|咽喉疼痛]]的最常见原因，与咳嗽一起，美国每年有190多万人被诊断为急性咽炎。<ref name="Rosen2010" /> |
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== 参考文献 == |
== 参考文献 == |
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2021年8月6日 (五) 14:31的版本
| 咽炎 | |
|---|---|
| 同义词 | 急性嗓子疼痛 |
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| 病毒性咽炎。注意红肿。 | |
| 读音 | |
| 症状 | 咽喉痛、发热、流鼻涕、咳嗽、头疼、声音沙哑[1][2] |
| 併發症 | 鼻竇炎、急性中耳炎[2] |
| 病程 | 3至5天[2] |
| 肇因 | 一般是通过病毒感染[2] |
| 診斷方法 | 按症状，快速抗原测试、咽拭[2] |
| 相似疾病或共病 | 会厌炎, 甲状腺炎, 咽后脓肿[2] |
| 治療 | 非甾体抗炎药、利多卡因[2][3] |
| 盛行率 | 发病率约每三个月7.5%（美國）[4] |
| 分类和外部资源 | |
| 醫學專科 | 传染病 |
| ICD-11 | CA02 |
| ICD-9-CM | 462、472、478.20 |
| DiseasesDB | 24580 |
| MedlinePlus | 000655 |
| eMedicine | 764304 |
咽炎（英語：Pharyngitis）是指人類喉部深處，即俗稱咽（咽喉后部）出现的炎症。[2]通常会导致咽喉痛、 发热。[2]其他病徵可能包括流鼻水还可能有流鼻涕、咳嗽、头痛、声音沙哑等症状。[1][5]通常会持续3到5天。[2]也可能并发鼻竇炎、急性中耳炎。[2]咽炎是一种上呼吸道感染。[6]
大多数病例是由病毒感染所致。[2]而链球菌性咽喉炎是一种细菌感染所致，在美国，约25%的儿童和10%的成人患有此疾病。[2]比較少見的病因包括感染淋球菌或真菌等其他細菌，或是因抽煙、過敏及胃食道逆流而引起。[2][3]咽炎患者若已表現出明確的病毒感染症狀，例如感冒時，並不建議再作特別的檢查。[2]反之，則建議作抗原快篩（RAPD）或咽喉檢體培養（throat swab）。[2]其他疾病，如會厭炎、甲狀腺炎、咽後膿瘍及心臟病也可能會引起類似的症狀。[2]
給予病患如布洛芬（ibuprofen）等非類固醇抗發炎藥物（NSAIDs）可有助於減緩疼痛。[2]服用利多卡因（lidocaine）混合溶液也有效果。[3]链球菌性咽喉炎則通常使用盤尼西林或阿莫西林等抗生素治療。[2]類固醇雖可用以治療情況嚴重的病患，但是否對急性咽炎也有效，則尚不明確，但最近（2020年）的一项审查发现，当与抗生素联合使用时，类固醇可适度改善疼痛和缓解的可能性。[7][8]
在美國，約有7.5%的人每3個月就會感到1次喉嚨痛。[4]而每年罹患2至3次咽炎也非罕見。[1]2007年在美國因此症就診的人數高達1500萬人。[3]咽炎是引起咽喉痛的最常见原因。[9]英文「Pharyngitis」這個字是源自希臘文「pharynx」，意為「喉嚨」，然後再加上「itis」，意為「發炎」的字尾。[10][11]
分类
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咽炎是由上呼吸道感染引起的一种炎症。可分为急性或慢性。急性咽炎可能是卡他性、化脓性或溃疡性的，这取决于病原体和患者的免疫能力。慢性咽炎可为卡他性、肥厚性或萎缩性。
扁桃体炎是咽炎的一个亚型。[12]如果炎症包括扁桃体和喉咙的其他部位，则可称为咽鼓管炎或扁桃体咽炎。[13]另一个亚类是鼻咽炎（普通感冒）。[14]
原因
大多数病例是由于与受感染者密切接触而获得的病原体所致。
病毒性
这些疾病约占所有感染病例的40-80%，可能是许多不同类型病毒感染的一个特征。[9][15]
细菌性
许多不同的细菌可以感染人的喉咙。最常见的是A组链球菌（化脓性链球菌），但其它包括肺炎链球菌、流感嗜血杆菌、百日咳杆菌、炭疽杆菌、白喉棒状杆菌、淋球菌、肺炎衣原体、肺炎支原体和坏死梭杆菌。[16]
- 链球菌性咽炎
链球菌性咽炎或链球菌性咽喉炎是由化脓性链球菌引起的。[17]它是咽炎病例最常见的细菌原因（15-30%）。 [16]常见症状包括发烧、喉咙痛和淋巴结肿大。 它是一种传染性感染，通过与感染者的密切接触传播。 根据咽喉细菌培养结果作出明确诊断。 抗生素可用于预防并发症（如风湿热）和加速康复。[18]
- 坏死梭杆菌
坏死梭杆菌是口咽微生物群的正常居民，偶尔可造成扁桃体周围脓肿。在400例未经治疗的病例中，有1例发生Lemierre综合征。[19]
- 白喉
白喉是由白喉棒状杆菌引起的一种可能危及生命的上呼吸道感染，自儿童疫苗接种计划实施以来，发达国家已基本根除了白喉棒状杆菌，但在第三世界仍有报道，在东欧的一些地区也有越来越多的报道。抗生素在早期是有效的，但恢复通常很慢。
- 其他
其他一些原因很少见，但可能致命，包括咽旁间隙感染：扁桃体周围脓肿（“昆西脓肿”）、下颌下间隙感染（Ludwig心绞痛）和会厌炎。[20][21][22]
真菌性
有些咽炎是由真菌感染引起的，如白色念珠菌，引起口腔鹅口疮。[23]
非感染性
咽炎也可能由机械、化学或热刺激引起，例如冷空气或胃食道逆流。一些药物可能产生咽炎，如普拉克索和抗精神病药。[24][25]
诊断
| 积分 | 链球菌感染概率 | 处理手段 |
|---|---|---|
| 1或更少 | <10% | 不需要抗生素或培养 |
| 2 | 11–17% | 基于培养或快速抗原试验的抗生素 |
| 3 | 28–35% | |
| 4或5 | 52% | 经验性治疗 |
仅根据症状很难区分引起喉咙痛的病毒和细菌原因。[26]因此，通常用取样来排除细菌的原因。[27]
修改后的Centor标准可用于确定咽炎患者的治疗方法。根据五项临床标准，它表明链球菌感染的可能性。[18]
每项标准得1分：[18]
- 没有咳嗽
- 颈部淋巴结肿痛
- 温度超过 38.0 °C（100.4 °F）
- 扁桃体渗出或肿胀
- 年龄小于15岁（如果年龄大于44岁，则减去一分）
美国传染病协会建议不要进行经验性治疗，认为只有在检测呈阳性后才适合使用抗生素。三岁以下的儿童不需要检测，因为A组链球菌和风湿热都很罕见，除非他们有一个患有该病的兄弟姐妹。[26]
处理手段
大多数情况下，治疗是对症的。 特定治疗对细菌、真菌和单纯疱疹感染有效。
药物治疗
- 镇痛药，如非甾体抗炎药和对乙酰氨基酚（扑热息痛），可以帮助减轻与喉咙痛有关的疼痛。阿司匹林可用于成人，但由于有雷尔氏综合征的风险，不建议用于儿童。[28]
- 类固醇（如地塞米松）可能对严重咽炎有用。[29][8]然而，它们的普遍使用缺乏支持。[7]
- 粘性利多卡因通过麻痹黏膜来缓解疼痛。[30]
- 如果喉咙痛是由细菌感染引起的，抗生素是有用的。[31][32]对于病毒感染，抗生素没有效果。在美国，25%的人在发现细菌感染之前使用了抗生素。[33]
- 口服镇痛剂溶液，其有效成分通常是苯酚，但也有不太常见的苯佐卡因、西吡氯铵和/或薄荷醇。Chloraseptic和思必乐是这类镇痛剂品牌的两个例子。
替代疗法
经常有人建议用盐水漱口，但缺乏证明其作用的证据。[3]替代医学被提倡并用于治疗咽喉疼痛。然而，它们没有得到充分的证据支持。[34]
流行病学
急性咽炎是导致咽喉疼痛的最常见原因，与咳嗽一起，美国每年有190多万人被诊断为急性咽炎。[9]
参考文献
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