登革熱與肥胖之關係探討

The association between obesity and dengue

登革熱在全球的罹病人數依然居高不下，而台灣地處亞洲與熱帶、亞熱帶區域，過去也曾發生過多次大流行造成社會及醫療系統龐大的負擔，故如何早期分辨出可能轉成嚴重登革熱的個案，給予正確治療策略是決定病人預後關鍵的課題。在世界衛生組織的登革熱指引中，肥胖被列為嚴重登革熱的風險因子，建議需住院觀察治療，肥胖患者往往伴隨著許多共病，也常常是許多感染症的不良預後因子。臨床研究中也發現肥胖者在感染登革病毒後比非肥胖者，其血小板的數據最低值更低、血比容上升的速度與血小板下降的速度更快、平均的肝指數更高、需要住院超過三天的比例也較多，所以在全球肥胖人口日益增加的趨勢下，肥胖登革熱感染者的評估在臨床上是個值得關注的議題。

The annual number of global dengue cases is increasing. Taiwan, located in tropical and subtropical areas, has experienced several dengue outbreaks in history. Some of these outbreaks have caused tremendous medical and social impacts. It is critical to recognize the risk factors for severe dengue. According to the 2009 World Health Organization dengue guidelines, obesity is a risk factor for severe dengue requiring hospitalization. Obesity is associated with several comorbidities and is a risk factor for poor prognosis in many infectious diseases. Previous studies have reported that obese dengue patients had lower platelet nadir values, more rapidly increasing hematocrit and decreasing platelets, higher liver enzyme values, and higher duration of hospitalization, longer than 3 days, compared with non-obese dengue patients. With a global increase in the obese population, the evaluation and management of diseases in patients with obesity is an important clinical issue.