嬰兒細支氣管炎鑑別診斷與治療

Differential Diagnosis and Treatment of Infant Bronchiolitis

細支氣管炎是嬰兒期最常見的喘鳴疾病，其嬰兒期發生率可高達30% 以上。我們追蹤一千多個從出生到18 個月嬰兒的研究發現，每3 個嬰兒就有1 個嬰兒得過細支氣管炎，而且每6 個嬰兒就有1 個會至少3 次（含）以上的細支氣管炎發生。多半的嬰兒細支氣管炎者會有呼吸急促，且合併發燒、咳嗽和運動與吸奶時呼吸急促。細支氣管炎有5 大成因，包括：感染、過敏、早產、男生和基因體質。其中感染和特定基因型（例如克雷拉蛋白質10，CC10，基因多型性者）扮演最主要角色；相反地！嬰兒期過敏性細支氣管炎則很少。嬰兒需要在下列情況才會考慮過敏性氣喘：1) 嬰兒反覆出現細支氣管炎，並且血中出現特殊吸入性過敏抗體，2) 有異位性皮膚炎嬰兒，出現反覆細支氣管炎，3) 有過敏父母親的嬰兒出現反覆細支氣管炎。以上這三類氣管炎需要考慮嬰兒氣喘之外，其他類的嬰兒細支氣管炎多半在3 歲後不再發生細支氣管炎。

Acute bronchiolitis is the most common wheezing disorder during infancy.Incidence of bronchiolitis during infancy can exceed 30%. In a birth cohort study, more than one-third of infants had bronchiolitis before 18 months of age, and one-sixth of infants had more than three bronchiolitis attacks. Infants with onchiolitis had respiratory distress in combination with fever, cough, exerciseand feeding-exacerbation. Causes of bronchiolitis could be categorized into five major subtypes, namely infection, allergy, prematurity, male gender and genetic polymorphisms. Of the causes, infection and genetic polymorphism (e.g., Clara cell protein 10, CC10) play the most important roles; in contrast, allergic sensitization is not the major cause. Only wheezing infants with specific IgE to aeroallergen and atopic dermatitis or whose parents had atopic diseases were considered to have infantile asthma. Wheezing infants without risk factors to asthma usually recovered from wheezing episodes after 3 years of age.