2009 年世界衛生組織登革熱臨床新分類概述

Overview of the New Dengue Classification by the World Health Organization, 2009

登革熱近年來在罹病人數及地域上都有快速擴展的現象，對於原本根據東南亞兒童研究，所訂定的舊版世界衛生組織(WHO)登革熱指引的實用性，開始有爭論產生，例如：針對登革熱嚴重度的預測性受到質疑、對於資源有限國家診斷上所需檢驗執行的困難、壓脈帶試驗的實用性等都有所討論，另外是否可以反映整個疾病的特性更是爭論的重點。世界衛生組織根據一個多國參與的研究結果，在2009年出版新版登革熱指引，不再特別強調登革出血熱，而是將有症狀登革病毒感染分為登革熱及嚴重登革熱，並將嚴重的臨床表現如血漿滲漏導致的休克及呼吸窘迫、器官的侵犯及嚴重出血等，納入所謂“嚴重登革熱”的診斷中。此新版的指引，在應用上還有待更多文獻的支持，另外是不是適合台灣使用也需要更多的研究與討論。

IIn recent years, there has been a rapid increase in the incidence and geographic proliferation of dengue. The previous dengue classification proposed by the World Health Organization (WHO) was derived from a study on Southeast Asian children and was based on the prediction of dengue severity. However, there has been much debate on this classification system because of the difficulty faced by resource-limited countries in performing the examination required for applying the old WHO dengue classification and the utility of the tourniquet test. Moreover, it remains unclear whether this classification system reflects the character of the dengue disease. In 2009, the WHO published a new dengue classification based on results of a prospective, multi-center study. The revised classification system ivided symptomatic dengue virus infection into dengue and severe dengue, rather than emphasizing dengue hemorrhagic fever. Severe dengue is characterized by several severe clinical manifestations such as plasma leakage leading to shock or respiratory distress, organ involvement, and heavy bleeding. However, further evidence is required to support the applicability of the revised dengue guidelines. In addition, further discussion and local data will help determine the usefulness of the revised guidelines in Taiwan.