夜間盜汗之臨床評估與鑑別診斷

Clinical Evaluation and Differential Diagnosis of Night Sweats

10.6200/TCMJ.2017.14.3.02

林宜靜(Yi-Ching Lin)；余文瑞(Wen-Ruey Yu)

夜間盜汗 ； night sweats

北市醫學雜誌

14卷3期（2017 / 09 / 30）

279 - 288

繁體中文

夜間盜汗(Night sweats) 為一臨床上不少見的主訴，雖然大部分患者的原因皆為良性或不明原因，但仍有少數嚴重的病症可能以夜間盜汗為主訴來呈現。面對夜間盜汗的病人，完整的病史詢問仍是最重要的評估方式，內容應包括：有無發燒、與其他診斷相關的症狀（如體重減輕、潮紅、心悸等）、排除特殊感染疾病如結核或愛滋以及詢問目前用藥。理學檢查應注意有無暗示其他診斷的發現，如甲狀腺腫大、淋巴結腫大、異常的皮疹等。基本的胸部X 光以及實驗室檢驗，包括血球計數與分型、促甲狀腺素、促濾泡成熟激素、病毒血清學檢驗或痰液抹片等，也可幫助排除許多診斷。目前夜間盜汗的治療，仍以處理原發疾病為原則。對於不明原因或診斷不明的夜間盜汗，建議仍以觀察為主。

Night sweats, as a common chief complaint in primary care settings, are mostly consequence of benign or idiopathic causes. However, some severe diseases may present night sweats as chief complaint, which we should always be aware of. Taking a complete history is still the most important part when approaching patients with night sweats, which should always include the presence of fever, symptoms that may indicate other diagnosis (such as body weight loss, hot flash, palpitation, etc.), ruling out infectious diseases like AIDS or tuberculosis, and current medications. Physical examinations should focus on the presence of lymphadenopathy, enlargement of thyroid gland, Osler's node or Janeway lesion besides of vital signs. Many diagnoses can be ruled out with the help of chest x-ray or laboratory data, including complete blood counts with differential counts, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), viral serology, and sputum cultures. The treatment of night sweats should aim on pathologic cause behind it. As for the patients with idiopathic or benign causes of night sweats, we suggest observations as main strategy. Empirical treatment is not recommended for night sweats currently.