症狀找原因
依症狀找可能疾病、看病科別及醫師
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<div class="pasteContent" style="display:inline;" _ngcontent-c40=""> <div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><div class="pasteContent" style="display: inline;" _ngcontent-c40=""> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">臺灣有超過</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">250</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">萬名</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎帶原者，因此</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">慢性</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎在臺灣是很重要的公衛議題</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">如果沒有好好監測與控制的話</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">,</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">很容易產生一些慢性</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝相關的併發症</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">,</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">例如肝硬化</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">, </span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝功能代償不全</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">(hepatic decompensation), </span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">甚至產生肝癌</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">。</span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒的大量複製以及活躍會持續造成肝細胞的傷害甚至會造成死亡</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">我們知道血液中的</span></span></span><span lang="EN-US"><span style="font-size: 12pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎病毒含量愈高</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">產生肝癌的機會就愈大</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">。</span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">因此，愈早使用</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎抗病毒藥物抑制病毒複製，減少發生肝細胞損傷、肝纖維化、肝硬化甚至肝癌的效果就愈好。</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><br> </span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"><br></span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><br></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span lang="EN-US"><span style="font-size: 12pt;"><br></span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span lang="EN-US"><span style="font-size: 12pt;"><img class="e-rte-image e-imginline e-resize" width="auto" height="auto" alt="Depositphotos_39584263_xl-2015.jpg" src="https://expert.med-net.com/upload/ArticleDetail/222/Depositphotos_39584263_xl-2015.jpg" style="min-width: 0px; min-height: 0px;"><br></span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"></span></span></p><div class="pasteContent" style="display:inline;" _ngcontent-c40=""><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;"><br></span></span></span></div><p></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"></span></span></p><div class="pasteContent" style="display:inline;" _ngcontent-c40=""> <!--StartFragment--><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;">但是，</span></span></span><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span lang="EN-US" style=" border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;">B</span></span></span></span><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;">型肝炎是一種很狡猾的病毒不容易根治。</span></span></span><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span lang="EN-US" style=" border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><br style=" font-family: "Noto Sans TC", sans-serif;"></span></span><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;">怎麼這麼說呢</span></span></span><span style=" background-color: rgb(255, 255, 255); color: rgb(136, 136, 136); font-family: "Times New Roman", Times, serif; font-size: 15px; font-style: normal; line-height: inherit; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span lang="EN-US" style=" border: 0px; font-family: inherit; font-size: 15px; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; font-family: inherit; font-size: 12pt; font-style: inherit; line-height: inherit; padding: 0px; vertical-align: baseline;"><span style=" border: 0px; color: rgb(0, 0, 0); font-family: inherit; font-size: 16px; font-style: inherit; line-height: inherit; padding: 0px; text-decoration: inherit; vertical-align: baseline;">?</span></span></span></span><!--EndFragment--> </div><br><p></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"></span></span></p><div class="pasteContent" style="display:inline;" _ngcontent-c40=""><br></div><p></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">我們知道</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒是不完整的雙股</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"> DNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">病毒，當感染正常的肝細胞後，</span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">病毒從細胞質進入到細胞核，在核內病毒會靠自己的酵素（</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">DNA polymerase</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">）和我們人類的肝細胞結合成為完整的共價雙股</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"> DNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，</span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">此時合成的新</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"> DNA </span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">稱為</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"> cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，並以此為病毒的複製模板，會經由轉錄（</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">transcription</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">）作</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">用製造出</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"> RNA </span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">的中間產物，</span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">也會經轉譯（</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">translation</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">）作用而製造出病毒複製所需的蛋白質等物質</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">; </span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: 新細明體, serif; font-size: 12pt;"><br></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">當我們身體抵抗力好的時候，</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒會躲在我們的肝細胞內，一旦我們變虛弱或是生病</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">(</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">例如</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">:</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">年紀大、癌症，糖尿病，免疫力降低</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">…</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">等</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">)</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，病毒就啟動複製專用的模板</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，可以一下子大量複製病毒並釋放出來作怪，造成肝臟反覆慢性發炎，久了就有可能演變成肝纖維化、肝硬化甚至肝癌。</span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: 新細明體, serif; font-size: 12pt;"><br></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒之所以難纏就是因為目前用來治療</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝的口服抗病毒藥物只能抑制</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒的複製，抑制血液中病毒的數量但是並無法真正清除肝臟細胞核內的</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">，這就是為何</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒在停藥後容易復發的原因。</span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><span class="e-img-caption e-caption-inline" _ngcontent-c40="" contenteditable="false" draggable="false"><span class="e-img-wrap" _ngcontent-c40=""><img class="e-rte-image e-imginline e-resize" width="auto" height="auto" alt="圖片4.jpg" src="https://expert.med-net.com/upload/ArticleDetail/222/圖片4.jpg" style="min-width: 0px; min-height: 0px; outline: rgb(74, 144, 226) solid 2px;"><span class="e-img-inner" _ngcontent-c40="" contenteditable="true"></span></span></span></span></span></p><div class="pasteContent" style="display:inline;" _ngcontent-c40=""> <!--StartFragment--><b style=" background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-family: Lato, sans-serif; font-size: 15px; font-style: normal;padding: 0px; text-align: center; text-indent: 0px; vertical-align: baseline; white-space: normal;">adopted from: Viruses 2013, 5, 2690-2703</b><!--EndFragment--> </div><br><p></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">因</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">此，對抗</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎是一場長期抗戰，但究竟抗病毒藥物要吃多久呢</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">?</span></span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">研究顯示</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">: </span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">在持續使用抗病毒藥物的情況下</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">,</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">身體免疫力清除感染</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">的肝臟細胞平均需</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">14.5</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">年。</span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">在這個過程中</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">,</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">抗病毒治療可阻斷</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">的循環</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">,</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">降低</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">新生。</span></span></span></p><p style="margin: 0cm 0cm 0.0001pt;"><span lang="EN-US" style=""><font face="新細明體, serif"><span style="font-size: 16px;"><br></span></font> </span><span style="font-family: "Times New Roman", Times, serif;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">但是以臺灣健保的給付規定來說，一旦符合健保條件開始用藥，除了一些特殊條件是可以終生健保給付外，大多數的給付條件是有期限的</span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">: </span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">(</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">詳情請參照</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">:</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">中央健保局慢性</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">型肝炎抗病毒用藥之給付規定</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">)</span></span></span></span></p> <ol level="1" style="font-family: Lato, sans-serif; font-size: 15px; margin-bottom: 0cm;"><li style="font-size: 12pt;"><p><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"><span style="font-family: "Times New Roman", Times, serif;">(1)<strong>HBeAg 陽性</strong>病患治療至 e 抗原轉陰並再給付<strong>最多 12 個月治療</strong>。</span></span></span></p></li><li style="font-size: 12pt;"><p><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"><span style="font-family: "Times New Roman", Times, serif;">(2)<strong>HBeAg 陰性</strong>病患治療至少二年，治療期間需檢驗血清 HBVDNA ，並於檢驗血清 HBV DNA 連續三次，每次間隔 6 個月，</span></span></span></p></li><li style="font-size: 12pt;"><p><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;"><span style="font-family: "Times New Roman", Times, serif;">均檢驗不出 HBV DNA 時可停藥，每次療程<strong>至多給付 36 個月</strong>。</span></span></span></p></li></ol> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">臺灣的</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝健保給付條件是參考大型研究所制定的，但是礙於健保資源是有限的，雖然許多醫界的先進仍在替病友們極力爭取，但目前藥物健保大多仍然無法終生給付。</span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">很多文獻都已經證實 在現階段還沒有很好的清除肝細胞內</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">cccDNA</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">的時代，不間斷持續的使用抗</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝病毒藥物的治療不但可以減少肝細胞損傷、肝纖維化、肝硬化甚至肝癌甚至是發生</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝功能代償不全或是肝衰竭的機會</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">。因此當健保的抗</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝藥物到期後，倘若</span><span style="color: rgb(255, 0, 0); text-decoration: inherit;"><strong>經濟上許可建議繼續自費使用</strong></span><span style="color: rgb(0, 0, 0); text-decoration: inherit;">減少相關併發症。</span></span></span></p> <p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">再者，以目前的文獻看起來許多抗病毒藥物在停藥後有</span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span lang="EN-US"><span style="font-size: 12pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">B</span></span></span></span><span style="font-family: "Times New Roman", Times, serif;"><span style="font-size: 14pt;"><span style="color: rgb(0, 0, 0); text-decoration: inherit;">肝復發的情形，若</span><span style="color: rgb(255, 0, 0); text-decoration: inherit;"><strong>要停藥務必和您的臨床醫師做充分的溝通以及完整的評估及嚴密的追蹤。</strong></span></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><span class="e-img-caption e-caption-inline" _ngcontent-c40="" contenteditable="false" draggable="false"><span class="e-img-wrap" _ngcontent-c40=""><img class="e-rte-image e-imginline e-resize" width="auto" height="auto" alt="圖片2.png" src="https://expert.med-net.com/upload/ArticleDetail/222/圖片2.png" style="min-width: 0px; min-height: 0px; outline: rgb(74, 144, 226) solid 2px;"><span class="e-img-inner" _ngcontent-c40="" contenteditable="true"></span></span></span></span></span></p><div class="pasteContent" style="display:inline;" _ngcontent-c40=""> <!--StartFragment--><span style="font-size: 14pt;"><strong><span style="color: rgb(0, 0, 0); text-decoration: inherit;">美國/歐洲/亞太肝臟學會對於何時可考慮停用B肝抗病毒藥物的建議</span></strong></span><!--EndFragment--> </div><br><p></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p><p style="font-family: Calibri, sans-serif; font-size: 15px; margin: 0cm 0cm 0.0001pt;"><span style="font-family:"新細明體",serif;"><span style="font-size: 12pt;"><br></span></span></p> </div><br></div><div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><br></div><div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><br></div><div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><br></div><div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><br></div><div style="background: 0px 0px rgb(255, 255, 255); border: 0px; color: rgb(136, 136, 136); font-weight: 400; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><div class="pasteContent" style="display:inline;" _ngcontent-c40=""> <!--StartFragment--><strong style=" background-color: rgb(255, 255, 255); color: rgb(51, 51, 51); font-family: "Noto Sans TC", sans-serif; font-size: 14px; font-style: normal; line-height: inherit; max-width: 100%; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" background-color: rgb(255, 255, 255); color: rgb(51, 51, 51); display: inline !important; font-family: "Noto Sans TC", sans-serif; font-size: 18.6667px; font-style: inherit; line-height: inherit; max-width: 100%; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><div class="pasteContent" _ngcontent-c40="" style=" border: 0px; display: inline; font-family: "Noto Sans TC", sans-serif; font-size: 18.6667px; font-style: inherit; line-height: inherit; max-width: 100%; padding: 0px; vertical-align: baseline;"><span style=" background-color: rgb(245, 245, 245); color: rgb(0, 0, 0); display: inline !important; font-family: "Noto Sans TC", sans-serif; font-size: 13.33px; font-style: normal; line-height: inherit; max-width: 100%; padding: 0px; text-align: left; text-indent: 0px; vertical-align: baseline; white-space: normal;">◎撰文/台北醫學大學附設醫院肝膽腸胃科主治醫師方冠傑</span><span style=" background-color: rgb(255, 255, 255); color: rgb(51, 51, 51); display: inline !important; font-family: "Noto Sans TC", sans-serif; font-size: 14px; font-style: inherit; line-height: inherit; max-width: 100%; padding: 0px; text-align: start; text-indent: 0px; vertical-align: baseline; white-space: normal;"><span style=" border: 0px; font-family: inherit; font-size: 14px; font-style: inherit; line-height: inherit; max-width: 100%; padding: 0px; vertical-align: baseline;"> </span></span></div></span></strong><!--EndFragment--> </div><br></div></div>
方冠傑
2020:04:05
醫學新知
依症狀找可能疾病、看病科別及醫師