- 期刊
鼻炎的臨床表現及診斷
Clinical Manifestation and Diagnosis of Rhinitis
摘要
鼻炎為鼻內部黏膜之炎症，過去以鼻塞、鼻癢、打噴嚏及流鼻水等為經典症狀表現，近年來更強調慢性咳嗽的病人應把鼻炎放入鑑別診斷。鼻炎初步可區分為過敏性鼻炎及非過敏性鼻炎。目前過敏性鼻炎的臨床分型，是依據ARIA（Allergic Rhinitis and its Impact on Asthma）所建議的，以嚴重程度和持續時間為基礎來分類，目前已廣為國際醫界所接受。而非過敏性鼻炎，則包含了許多有別於過敏性鼻炎的鼻病，種類繁多、病因不一、且無專一特殊診斷工具，診斷上較為困難。鼻炎之臨床診斷，詳細的病史及理學檢查仍是最重要的，因為較不具專一性，臨床上可初步臆斷先行治療（therapeutic trial）來輔助診斷。醫師可依治療結果追蹤分析其療效，並適時修正診斷；對於藥物治療反應不如預期，診斷不明確的病患，應進行過敏原測試，並視需要安排特殊檢查：如內視鏡、電腦斷層等，以協助鑑別診斷。本文標題所謂的『診斷』，重點放在『鑑別診斷』，真正的過敏原測試則另有專文詳述。
並列摘要
Rhinitis is defined as inflammation of the nose lining manifested by one or more of the following symptoms: nasal congestion, rhinorrhea, sneezing, itching, and cough. The Allergic Rhinitis and Its Impact on Asthma Guidelines have reclassified allergic rhinitis based on the severity and duration of symptoms and are widely accepted internationally. Non-allergic rhinitis comprises various nasal conditions, and a definite diagnosis can be complex and difficult to make. A detailed history and physical examination remain the most important aspects of diagnosing rhinitis. Therapeutic trials can be initiated in patients with uncertain diagnoses. Physicians must follow treatment results and timely correct the diagnosis. For patients with an uncertain diagnosis and a poor response to initial treatment, allergen tests and other special examinations such as endoscopy or computed tomography should be arranged to assist in the differential diagnosis of rhinitis.