季節性流感之診斷與治療

Diagnosis and Treatment of Seasonal Influenza

黃妙慧(Miao-Hui Huang) ； 盛望徽(Wang-Huei Sheng) ； 胡婉妍(Un-In Wu)

《內科學誌》 31卷1期 (2020/02) Pp. 11-17

https://doi.org/10.6314/JIMT.202002_31(1).04

摘要

流感的臨床表現可從無症狀的感染、發燒合併呼吸道及全身性症狀、到發展為重症合併肺部或肺外併發症，此間免疫不全的患者常有不典型的臨床表現。在評估病人是否患有流感時，應依據患者之臨床症狀及流行病學逕行診斷，不可過度倚賴檢驗結果。目前國內外的診斷與治療指引，乃依照患者併發流感重症之風險高低、疾病嚴重度、以及時值流行期間與否，提供相對應之流感檢測與治療建議。流感檢驗方法包括抗原檢測、核酸檢測、血清檢驗及病毒培養等，其中核酸檢測被視為首選的檢驗方法。抗病毒藥物治療方面，非流感重症高危險族群的病症通常為自限性；但若患者屬重症高風險族群、或是已出現危險徵兆乃至併發重症，則建議及早使用抗病毒藥物。國內現已上巿的抗流感病毒藥物分為以neuraminidase inhibitor為機轉的oseltamivir（口服劑型）、peramivir（針劑注射）、zanamivir（吸入劑型），以及cap-dependent endonuclease inhibitor為機轉的baloxavir（口服劑型），個別藥物之選擇、治療劑量與療程須以宿主因素及疾病嚴重度調整。本文目的為透過彙整現今國內外流感最新的診治指引，協助第一線醫師判斷合適投予各種抗流感病毒藥物的時機，以達到減少不必要的抗生素使用、並預防流感重症之發生與避免社區傳播之目的。

關鍵字

季節性流感（Influenza） ； 流感快速篩檢（Rapid influenza diagnostic tests） ； 核酸檢驗（Nucleic acid test） ； 即時聚合酶連鎖反應（Real-time PCR） ； 克流感（Oseltamivir） ； 瑞貝塔（Peramivir）

並列摘要

Influenza has a broad spectrum of clinical manifestations that range from asymptomatic infection, to febrile respiratory illness with systemic signs and symptoms, and even to severe pulmonary or extrapulmonary complications. Notably, immunocompromised patients may also present without typical findings of influenza. The management of a patient with suspected influenza should be based on clinical judgement and local epidemiological factors, and should not be directed by laboratory results alone. Current guidelines provide recommendations for proper selection of diagnostic modalities and antiviral agents based on the risk assessment of complications, disease severity, and the influenza activity in the community. Available influenza tests include antigen detection, nucleic acid amplification tests, serologic testing and viral culture. Of these, nucleic acid amplification tests are most recommended to improve detection of influenza virus infection. While uncomplicated influenza is usually self-limited among patients without risk factors of complications, antiviral therapy should be prescribed immediately to patients at high risk of complicated influenza, those with danger signs or severe infection. Approved antiviral agents include neuraminidase inhibitors (oral oseltamivir, inhaled zanamivir, and intravenous peramivir) and cap-dependent endonuclease inhibitor (oral baloxavir). Selection of these antiviral agents and adjustment of the dosage and treatment duration have to be tailored according to the host factors and disease severity. In this article, we summarize major recommendations put forward by recent guidelines for the diagnosis and treatment of influenza, including use of various diagnostic tools and antiviral agents. We aim to facilitate clinicians in making more timely and appropriate diagnosis in order to avoid unnecessary antibiotics use, and to reduce risk of post-influenza complications and disease transmission.